|
HC BRONCHOSCOPY,TRANSBRON ASPIR BX
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
3613162901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$6,671.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,504.79
|
| Rate for Payer: Aetna Government |
$4,504.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,153.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,153.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,153.35
|
| Rate for Payer: Brighton Health Commercial |
$6,671.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,504.79
|
| 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 |
$4,504.79
|
| Rate for Payer: EmblemHealth Commercial |
$4,504.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,054.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,829.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,009.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,504.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,009.26
|
| Rate for Payer: Group Health Inc Commercial |
$4,504.79
|
| Rate for Payer: Group Health Inc Medicare |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,610.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$205.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,829.07
|
| Rate for Payer: Healthfirst QHP |
$4,504.79
|
| Rate for Payer: Humana Medicare |
$4,594.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,504.79
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,504.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,504.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,279.55
|
| Rate for Payer: Wellcare Medicare |
$4,279.55
|
|
|
HC BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Facility
|
OP
|
$4,535.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
3613164501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.94 |
| Max. Negotiated Rate |
$3,401.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,106.99
|
| Rate for Payer: Aetna Government |
$2,106.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,474.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,474.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,474.89
|
| Rate for Payer: Brighton Health Commercial |
$3,401.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,106.99
|
| 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 |
$2,106.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,106.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,896.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,790.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,875.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,106.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,875.22
|
| Rate for Payer: Group Health Inc Commercial |
$2,106.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,106.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,106.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$792.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,790.94
|
| Rate for Payer: Healthfirst QHP |
$2,106.99
|
| Rate for Payer: Humana Medicare |
$2,149.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,106.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,106.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,106.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,001.64
|
| Rate for Payer: Wellcare Medicare |
$2,001.64
|
|
|
HC BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Facility
|
IP
|
$4,535.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
3613164501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,267.50 |
| Max. Negotiated Rate |
$2,267.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,267.50
|
|
|
HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
3028662201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.93
|
| Rate for Payer: Aetna Government |
$8.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.25
|
| Rate for Payer: Brighton Health Commercial |
$16.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.93
|
| Rate for Payer: EmblemHealth Commercial |
$8.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.95
|
| Rate for Payer: Group Health Inc Commercial |
$8.93
|
| Rate for Payer: Group Health Inc Medicare |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.93
|
| Rate for Payer: Healthfirst QHP |
$8.93
|
| Rate for Payer: Humana Medicare |
$9.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.93
|
| Rate for Payer: United Healthcare Commercial |
$11.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$8.04
|
|
|
HC BRUCELLA, ANTIBODY - BRUCELLA SPECIES ANTIBODY
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
3028662201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.00
|
|
|
HC BRUSH BIOPSY,TRANSCATH,RENAL
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 52007 TC
|
| Hospital Charge Code |
3615200701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$539.89 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$539.89
|
| Rate for Payer: Aetna Government |
$539.89
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$4,571.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,571.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,199.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC BRUSH BIOPSY,TRANSCATH,RENAL
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 52007 TC
|
| Hospital Charge Code |
3615200701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC BUPRENORPHINE TAKE-HOME ADMIN WK2
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT H0030
|
| Hospital Charge Code |
900H003001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$68.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.32
|
| Rate for Payer: Aetna Government |
$5.32
|
| Rate for Payer: Brighton Health Commercial |
$64.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.48
|
| Rate for Payer: EmblemHealth Commercial |
$43.00
|
| Rate for Payer: Group Health Inc Commercial |
$43.00
|
| Rate for Payer: Group Health Inc Medicare |
$30.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$43.00
|
|
|
HC BUPRENORPHINE TAKE-HOME ADMIN WK2
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT H0030
|
| Hospital Charge Code |
900H003001
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$43.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.00
|
|
|
HC BUPRENORPHNE DISPENSE BDL WK1,3,4
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT G2068
|
| Hospital Charge Code |
900G206801
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$130.00
|
|
|
HC BUPRENORPHNE DISPENSE BDL WK1,3,4
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT G2068
|
| Hospital Charge Code |
900G206801
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$772.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$143.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$284.13
|
| Rate for Payer: Aetna Government |
$284.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$772.64
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$772.64
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$343.40
|
| Rate for Payer: Amida Care Medicaid |
$343.40
|
| Rate for Payer: Brighton Health Commercial |
$195.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$208.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$176.80
|
| Rate for Payer: EmblemHealth Commercial |
$130.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$772.64
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$343.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$343.40
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$772.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$772.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$360.56
|
| Rate for Payer: Group Health Inc Commercial |
$130.00
|
| Rate for Payer: Group Health Inc Medicare |
$91.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$343.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$343.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.40
|
| Rate for Payer: Healthfirst Essential Plan |
$772.64
|
| Rate for Payer: Healthfirst QHP |
$559.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$343.40
|
| Rate for Payer: SOMOS Essential |
$772.64
|
| Rate for Payer: United Healthcare Commercial |
$130.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$772.64
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$377.73
|
| Rate for Payer: United Healthcare Medicaid |
$343.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$343.40
|
|
|
HC BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
3611908501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$197.42 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$197.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 19085
|
| Hospital Charge Code |
3611908501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
3611908101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.31 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$180.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 19081
|
| Hospital Charge Code |
3611908101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
3611908301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 19083
|
| Hospital Charge Code |
3611908301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$169.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
3611908601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.64
|
| Rate for Payer: Aetna Government |
$78.64
|
| Rate for Payer: Brighton Health Commercial |
$781.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Medicare |
$364.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$98.21
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 19086
|
| Hospital Charge Code |
3611908601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$521.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
|
|
HC BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
3611908201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.75
|
| Rate for Payer: Aetna Government |
$72.75
|
| Rate for Payer: Brighton Health Commercial |
$781.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Medicare |
$364.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.02
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 19082
|
| Hospital Charge Code |
3611908201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$521.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
3611908401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$521.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
|
|
HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 19084
|
| Hospital Charge Code |
3611908401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.16
|
| Rate for Payer: Aetna Government |
$68.16
|
| Rate for Payer: Brighton Health Commercial |
$781.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Commercial |
$521.00
|
| Rate for Payer: Group Health Inc Medicare |
$364.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$521.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$521.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.41
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC BYPASS GRAFT AORTOFEMORAL
|
Facility
|
IP
|
$5,828.00
|
|
|
Service Code
|
CPT 35646 TC
|
| Hospital Charge Code |
3613564601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,914.00 |
| Max. Negotiated Rate |
$2,914.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,914.00
|
|
|
HC BYPASS GRAFT AORTOFEMORAL
|
Facility
|
OP
|
$5,828.00
|
|
|
Service Code
|
CPT 35646 TC
|
| Hospital Charge Code |
3613564601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$4,371.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,205.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,960.15
|
| Rate for Payer: Aetna Government |
$1,960.15
|
| Rate for Payer: Brighton Health Commercial |
$4,371.00
|
| 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 |
$2,914.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,914.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,039.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,914.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,914.00
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
