|
HC BIOPSY THYROID, PERCUTANEOUS
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
3616010001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC BIOPSY THYROID, PERCUTANEOUS
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 60100 TC
|
| Hospital Charge Code |
3616010001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.78
|
| Rate for Payer: Aetna Government |
$83.78
|
| Rate for Payer: Brighton Health Commercial |
$1,385.25
|
| 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 |
$923.50
|
| Rate for Payer: Group Health Inc Commercial |
$923.50
|
| Rate for Payer: Group Health Inc Medicare |
$646.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.78
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC BIOPSY, TONGUE, ANTE TWO THIRDS
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
5104110001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC BIOPSY, TONGUE, ANTE TWO THIRDS
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
5104110001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.48 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| 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 |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$124.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC BIOPSY VAGINAL MUCOSA, EXTENSIVE
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
3615710501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC BIOPSY VAGINAL MUCOSA, EXTENSIVE
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 57105
|
| Hospital Charge Code |
3615710501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.41 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$5,674.50
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.41
|
| 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 |
$1,468.00
|
| 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 BIOPSY VAGINAL MUCOSA, SIMPLE
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,063.89
|
| Rate for Payer: Aetna Government |
$1,063.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$744.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$744.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$744.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.89
|
| 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 |
$1,063.89
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$904.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$946.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$946.86
|
| 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 |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.31
|
| Rate for Payer: Healthfirst QHP |
$1,063.89
|
| Rate for Payer: Humana Medicare |
$1,085.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,117.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,063.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,010.70
|
| Rate for Payer: Wellcare Medicare |
$1,010.70
|
|
|
HC BIOPSY VAGINAL MUCOSA, SIMPLE
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 57100
|
| Hospital Charge Code |
5105710001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$966.50 |
| Max. Negotiated Rate |
$966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.50
|
|
|
HC BIOPSY,VULVA/PERINEUM,ADDL LESION
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.21
|
| Rate for Payer: Aetna Government |
$37.21
|
| 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 |
$53.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.82
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC BIOPSY,VULVA/PERINEUM,ADDL LESION
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 56606
|
| Hospital Charge Code |
5105660601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.00
|
|
|
HC BIOPSY VULVA/PERINEUM,ONE LESN
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
5105660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$966.50 |
| Max. Negotiated Rate |
$966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.50
|
|
|
HC BIOPSY VULVA/PERINEUM,ONE LESN
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 56605
|
| Hospital Charge Code |
5105660501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$1,117.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,063.89
|
| Rate for Payer: Aetna Government |
$1,063.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$744.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$744.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$744.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.89
|
| 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 |
$1,063.89
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$904.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$946.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$946.86
|
| 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 |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.31
|
| Rate for Payer: Healthfirst QHP |
$1,063.89
|
| Rate for Payer: Humana Medicare |
$1,085.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,117.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,063.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,010.70
|
| Rate for Payer: Wellcare Medicare |
$1,010.70
|
|
|
HC BITEWINGS-SINGLE FILM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT D0270
|
| Hospital Charge Code |
361D027001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$109.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| 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 |
$15.00
|
| 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 |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$107.58
|
| Rate for Payer: EmblemHealth Commercial |
$107.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.82
|
| 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 |
$107.58
|
| Rate for Payer: Group Health Inc Medicare |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.44
|
| 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
|
|
|
HC BITEWINGS-SINGLE FILM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT D0270
|
| Hospital Charge Code |
361D027001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC BLADDER ASPRIATION-INSERT SUPRAPUBIC CATHETER
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
3615110201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.29 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,502.91
|
| Rate for Payer: Aetna Government |
$2,502.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,752.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,752.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,752.04
|
| Rate for Payer: Brighton Health Commercial |
$4,023.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,502.91
|
| 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 |
$2,502.91
|
| Rate for Payer: EmblemHealth Commercial |
$2,502.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,252.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,127.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,227.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,502.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,227.59
|
| Rate for Payer: Group Health Inc Commercial |
$2,502.91
|
| Rate for Payer: Group Health Inc Medicare |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,127.47
|
| Rate for Payer: Healthfirst QHP |
$2,502.91
|
| Rate for Payer: Humana Medicare |
$2,552.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,502.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,502.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,377.76
|
| Rate for Payer: Wellcare Medicare |
$2,377.76
|
|
|
HC BLADDER ASPRIATION-INSERT SUPRAPUBIC CATHETER
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
3615110201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC BLADDER ASPRIATION-TROCAR/INTRACATHETER
|
Facility
|
OP
|
$2,752.00
|
|
|
Service Code
|
CPT 51101
|
| Hospital Charge Code |
3615110101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.54 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,243.07
|
| Rate for Payer: Aetna Government |
$1,243.07
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$870.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$870.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$870.15
|
| Rate for Payer: Brighton Health Commercial |
$2,064.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,243.07
|
| 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 |
$1,243.07
|
| Rate for Payer: EmblemHealth Commercial |
$1,243.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,118.76
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,056.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,106.33
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,243.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,106.33
|
| Rate for Payer: Group Health Inc Commercial |
$1,243.07
|
| Rate for Payer: Group Health Inc Medicare |
$1,243.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,243.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,056.61
|
| Rate for Payer: Healthfirst QHP |
$1,243.07
|
| Rate for Payer: Humana Medicare |
$1,267.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,243.07
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,243.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,243.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,180.92
|
| Rate for Payer: Wellcare Medicare |
$1,180.92
|
|
|
HC BLADDER ASPRIATION-TROCAR/INTRACATHETER
|
Facility
|
IP
|
$2,752.00
|
|
|
Service Code
|
CPT 51101
|
| Hospital Charge Code |
3615110101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,376.00 |
| Max. Negotiated Rate |
$1,376.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,376.00
|
|
|
HC BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
5105172001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.81 |
| Max. Negotiated Rate |
$856.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.53
|
| Rate for Payer: Aetna Government |
$815.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$570.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$570.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$570.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.53
|
| 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 |
$815.53
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$733.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$693.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.82
|
| 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 |
$815.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$49.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.20
|
| Rate for Payer: Healthfirst QHP |
$815.53
|
| Rate for Payer: Humana Medicare |
$831.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.53
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$815.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$774.75
|
| Rate for Payer: Wellcare Medicare |
$774.75
|
|
|
HC BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
5105172001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
3028661201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.00
|
|
|
HC BLASTOMYCES, ANTIBODY - BLASTOMYCES ANTIBODIES
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
3028661201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.90
|
| Rate for Payer: Aetna Government |
$12.90
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.03
|
| Rate for Payer: Brighton Health Commercial |
$69.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.90
|
| Rate for Payer: EmblemHealth Commercial |
$12.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.90
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.48
|
| Rate for Payer: Group Health Inc Commercial |
$12.90
|
| Rate for Payer: Group Health Inc Medicare |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.90
|
| Rate for Payer: Healthfirst QHP |
$12.90
|
| Rate for Payer: Humana Medicare |
$13.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare Commercial |
$16.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.90
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.61
|
|
|
HC BLD DRW CENTRAL/PERIPHERAL CATH,VENOUS
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
3613659201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC BLD DRW CENTRAL/PERIPHERAL CATH,VENOUS
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
3613659201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.78 |
| 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 |
$34.78
|
| 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 BLINK REFLEX TEST - BLINK REFLEX ELECTRODIAGNOSTIC TEST
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 95933 TC
|
| Hospital Charge Code |
9229593301
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$39.25 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.25
|
| Rate for Payer: Aetna Government |
$39.25
|
| Rate for Payer: Brighton Health Commercial |
$1,050.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,120.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$952.00
|
| Rate for Payer: EmblemHealth Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.68
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
|
