|
HC ANOSCOPY, DIAGNOSTIC
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
5104660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC ANOSCOPY, DIAGNOSTIC
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
5104660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| 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 |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
3614660001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$47.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
3614660001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
3614660801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,156.50 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.50
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
3614660801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.51 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,113.95
|
| Rate for Payer: Aetna Government |
$1,113.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$779.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$779.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$779.76
|
| Rate for Payer: Brighton Health Commercial |
$1,734.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.95
|
| 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 |
$1,113.95
|
| Rate for Payer: EmblemHealth Commercial |
$1,113.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.42
|
| Rate for Payer: Group Health Inc Commercial |
$1,113.95
|
| Rate for Payer: Group Health Inc Medicare |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.86
|
| Rate for Payer: Healthfirst QHP |
$1,113.95
|
| Rate for Payer: Humana Medicare |
$1,136.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,058.25
|
| Rate for Payer: Wellcare Medicare |
$1,058.25
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
7504660801
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,156.50 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.50
|
|
|
HC ANOSCOPY,REMOVE FOREIGN BODY - ENDOSCOPY, ANUS
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 46608
|
| Hospital Charge Code |
7504660801
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$101.51 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,113.95
|
| Rate for Payer: Aetna Government |
$1,113.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$779.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$779.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$779.76
|
| Rate for Payer: Brighton Health Commercial |
$1,734.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.95
|
| 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 |
$1,113.95
|
| Rate for Payer: EmblemHealth Commercial |
$1,113.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.42
|
| Rate for Payer: Group Health Inc Commercial |
$1,113.95
|
| Rate for Payer: Group Health Inc Medicare |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$101.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.86
|
| Rate for Payer: Healthfirst QHP |
$1,113.95
|
| Rate for Payer: Humana Medicare |
$1,136.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,058.25
|
| Rate for Payer: Wellcare Medicare |
$1,058.25
|
|
|
HC ANOSCOPY,W/CONTROL,BLEEDING - ENDOSCOPY, ANUS
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
3614661401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$3,078.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| 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 |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,440.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,440.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC ANOSCOPY,W/CONTROL,BLEEDING - ENDOSCOPY, ANUS
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 46614
|
| Hospital Charge Code |
3614661401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,052.50 |
| Max. Negotiated Rate |
$2,052.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.50
|
|
|
HC ANTEPARTUM CARE - 4-6 VISITS
|
Facility
|
IP
|
$1,215.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
5145942501
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$607.50 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$607.50
|
|
|
HC ANTEPARTUM CARE - 4-6 VISITS
|
Facility
|
OP
|
$1,215.00
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
5145942501
|
|
Hospital Revenue Code
|
514
|
| 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 |
$428.75
|
| Rate for Payer: Aetna Government |
$428.75
|
| 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 |
$607.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$607.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$520.08
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC ANTEPARTUM CARE - 7+ VISITS
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
5145942601
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,195.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,195.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$754.76
|
| Rate for Payer: Aetna Government |
$754.76
|
| 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 |
$1,087.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,087.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$956.94
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC ANTEPARTUM CARE - 7+ VISITS
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
5145942601
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$1,087.00 |
| Max. Negotiated Rate |
$1,087.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.00
|
|
|
HC ANTEPARTUM CARE, VAG DELIVERY OR POSTPARTUM CARE AFTER CESARIAN
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
7225961201
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,784.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,766.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,884.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,097.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC ANTEPARTUM CARE, VAG DELIVERY OR POSTPARTUM CARE AFTER CESARIAN
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 59612
|
| Hospital Charge Code |
7225961201
|
|
Hospital Revenue Code
|
722
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
|
HC ANTERIOR SEGMENT OF EYE PROC UNLISTED
|
Facility
|
IP
|
$6,123.00
|
|
|
Service Code
|
CPT 66999
|
| Hospital Charge Code |
5106699901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,061.50 |
| Max. Negotiated Rate |
$3,061.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.50
|
|
|
HC ANTERIOR SEGMENT OF EYE PROC UNLISTED
|
Facility
|
OP
|
$6,123.00
|
|
|
Service Code
|
CPT 66999
|
| Hospital Charge Code |
5106699901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,925.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,786.64
|
| Rate for Payer: Aetna Government |
$2,786.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,950.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,950.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,950.65
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,786.64
|
| 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 |
$2,786.64
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,507.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,368.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,480.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,786.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,480.11
|
| 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 |
$2,786.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,786.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,368.64
|
| Rate for Payer: Healthfirst QHP |
$2,786.64
|
| Rate for Payer: Humana Medicare |
$2,842.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,925.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,786.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,786.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,786.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,647.31
|
| Rate for Payer: Wellcare Medicare |
$2,647.31
|
|
|
HC ANTERIOVENOUS FISTULA BY NONAUTOGENOUS GRAFT
|
Facility
|
IP
|
$13,920.00
|
|
|
Service Code
|
CPT 36830
|
| Hospital Charge Code |
3613683001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,960.00 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
|
|
HC ANTERIOVENOUS FISTULA BY NONAUTOGENOUS GRAFT
|
Facility
|
OP
|
$13,920.00
|
|
|
Service Code
|
CPT 36830
|
| Hospital Charge Code |
3613683001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$777.73 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,604.79
|
| Rate for Payer: Aetna Government |
$6,604.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,623.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,623.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,623.35
|
| Rate for Payer: Brighton Health Commercial |
$10,440.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,604.79
|
| 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 |
$6,604.79
|
| Rate for Payer: EmblemHealth Commercial |
$6,604.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,944.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,614.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,878.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,604.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,878.26
|
| Rate for Payer: Group Health Inc Commercial |
$6,604.79
|
| Rate for Payer: Group Health Inc Medicare |
$6,604.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,604.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,009.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$777.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,614.07
|
| Rate for Payer: Healthfirst QHP |
$6,604.79
|
| Rate for Payer: Humana Medicare |
$6,736.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,604.79
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,604.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,604.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,274.55
|
| Rate for Payer: Wellcare Medicare |
$6,274.55
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTIBILITY CHARGE
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
|
|
HC ANTIBIOTIC SENS,DISK,EACH - SUSCEPTIBILITY CHARGE
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
3068718401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.48
|
| Rate for Payer: Aetna Government |
$7.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.24
|
| Rate for Payer: Brighton Health Commercial |
$13.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.48
|
| Rate for Payer: EmblemHealth Commercial |
$7.48
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.66
|
| Rate for Payer: Group Health Inc Commercial |
$7.48
|
| Rate for Payer: Group Health Inc Medicare |
$7.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.66
|
| Rate for Payer: Healthfirst Essential Plan |
$14.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.48
|
| Rate for Payer: Healthfirst QHP |
$7.48
|
| Rate for Payer: Humana Medicare |
$7.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.48
|
| Rate for Payer: United Healthcare Commercial |
$8.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.66
|
| Rate for Payer: Wellcare Medicare |
$6.73
|
|
|
HC ANTIBODY - CHIKUNGUNYA ABS, IGG/IGM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ANTIBODY - CHIKUNGUNYA ABS, IGG/IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679003
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.24
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
|
HC ANTIBODY - DENGUE VIRUS IGG AND IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
3028679004
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.88
|
| Rate for Payer: EmblemHealth Commercial |
$12.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.46
|
| Rate for Payer: Group Health Inc Commercial |
$12.88
|
| Rate for Payer: Group Health Inc Medicare |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.88
|
| Rate for Payer: Healthfirst QHP |
$12.88
|
| Rate for Payer: Humana Medicare |
$13.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.24
|
| Rate for Payer: Wellcare Medicare |
$11.59
|
|
