|
HC CERVICAL OR VAGINAL CA SCREENING
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
770G010101
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.35
|
| 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 |
$177.75
|
| 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 |
$189.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.16
|
| 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 |
$30.86
|
| 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: Senior Whole Health Medicare Advantage |
$113.02
|
| 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 CERVICAL OR VAGINAL CA SCREENING
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
770G010101
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC CESSATION THROMB INCL CATH REMOVAL & VASC CLSURE
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 37214 TC
|
| Hospital Charge Code |
3613721401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.11 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$148.11
|
| Rate for Payer: Aetna Government |
$148.11
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| 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 |
$2,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,470.00
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC CESSATION THROMB INCL CATH REMOVAL & VASC CLSURE
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
CPT 37214 TC
|
| Hospital Charge Code |
3613721401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
|
|
HC CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) FULL SEQUENCE
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 81223
|
| Hospital Charge Code |
3108122301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$349.30 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$765.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$499.00
|
| Rate for Payer: Aetna Government |
$499.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$349.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$349.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$349.30
|
| Rate for Payer: Brighton Health Commercial |
$499.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$499.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,112.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$945.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$499.00
|
| Rate for Payer: EmblemHealth Commercial |
$499.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$449.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$424.15
|
| Rate for Payer: Fidelis Essential Plan QHP |
$444.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$499.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$444.11
|
| Rate for Payer: Group Health Inc Commercial |
$499.00
|
| Rate for Payer: Group Health Inc Medicare |
$499.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$499.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$499.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$499.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$499.00
|
| Rate for Payer: Healthfirst QHP |
$499.00
|
| Rate for Payer: Humana Medicare |
$508.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$499.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$499.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$499.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$474.05
|
| Rate for Payer: Wellcare Medicare |
$449.10
|
|
|
HC CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) FULL SEQUENCE
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT 81223
|
| Hospital Charge Code |
3108122301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$695.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.50
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS CARRIER PANEL
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3008122003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$695.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.50
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS CARRIER PANEL
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3008122003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$765.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$556.60
|
| Rate for Payer: Aetna Government |
$556.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$389.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$389.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$389.62
|
| Rate for Payer: Brighton Health Commercial |
$1,043.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$556.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,112.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$945.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$556.60
|
| Rate for Payer: EmblemHealth Commercial |
$556.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$500.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$473.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.37
|
| Rate for Payer: Group Health Inc Commercial |
$556.60
|
| Rate for Payer: Group Health Inc Medicare |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Healthfirst Essential Plan |
$738.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.60
|
| Rate for Payer: Healthfirst QHP |
$556.60
|
| Rate for Payer: Humana Medicare |
$567.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.60
|
| Rate for Payer: United Healthcare Commercial |
$500.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Wellcare Medicare |
$500.94
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS DIAGNOSTIC STDY
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3008122001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$765.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$556.60
|
| Rate for Payer: Aetna Government |
$556.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$389.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$389.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$389.62
|
| Rate for Payer: Brighton Health Commercial |
$1,043.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$556.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,112.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$945.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$556.60
|
| Rate for Payer: EmblemHealth Commercial |
$556.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$500.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$473.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.37
|
| Rate for Payer: Group Health Inc Commercial |
$556.60
|
| Rate for Payer: Group Health Inc Medicare |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Healthfirst Essential Plan |
$738.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.60
|
| Rate for Payer: Healthfirst QHP |
$556.60
|
| Rate for Payer: Humana Medicare |
$567.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.60
|
| Rate for Payer: United Healthcare Commercial |
$500.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Wellcare Medicare |
$500.94
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS DIAGNOSTIC STDY
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3008122001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$695.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.50
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3108122002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$695.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.50
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
IP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3008122002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$695.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.50
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3108122002
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$765.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$556.60
|
| Rate for Payer: Aetna Government |
$556.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$389.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$389.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$389.62
|
| Rate for Payer: Brighton Health Commercial |
$556.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$556.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,112.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$945.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$556.60
|
| Rate for Payer: EmblemHealth Commercial |
$556.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$500.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$473.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.37
|
| Rate for Payer: Group Health Inc Commercial |
$556.60
|
| Rate for Payer: Group Health Inc Medicare |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Healthfirst Essential Plan |
$738.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.60
|
| Rate for Payer: Healthfirst QHP |
$556.60
|
| Rate for Payer: Humana Medicare |
$567.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Wellcare Medicare |
$500.94
|
|
|
HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS GENE TEST
|
Facility
|
OP
|
$1,391.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
3008122002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$328.25 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$765.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$556.60
|
| Rate for Payer: Aetna Government |
$556.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$389.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$389.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$389.62
|
| Rate for Payer: Brighton Health Commercial |
$1,043.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$556.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,112.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$945.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$556.60
|
| Rate for Payer: EmblemHealth Commercial |
$556.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$500.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$473.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$495.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$556.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$495.37
|
| Rate for Payer: Group Health Inc Commercial |
$556.60
|
| Rate for Payer: Group Health Inc Medicare |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$556.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$556.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Healthfirst Essential Plan |
$738.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$556.60
|
| Rate for Payer: Healthfirst QHP |
$556.60
|
| Rate for Payer: Humana Medicare |
$567.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$556.60
|
| Rate for Payer: United Healthcare Commercial |
$500.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$556.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$328.25
|
| Rate for Payer: Wellcare Medicare |
$500.94
|
|
|
HC CHANGE CYSTOSTOMY TUBE, COMPLICATED
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 51710 TC
|
| Hospital Charge Code |
3615171001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$842.50 |
| Max. Negotiated Rate |
$842.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.50
|
|
|
HC CHANGE CYSTOSTOMY TUBE, COMPLICATED
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 51710 TC
|
| Hospital Charge Code |
3615171001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.53 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$97.53
|
| Rate for Payer: Aetna Government |
$97.53
|
| Rate for Payer: Brighton Health Commercial |
$1,263.75
|
| 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 |
$842.50
|
| Rate for Payer: Group Health Inc Commercial |
$842.50
|
| Rate for Payer: Group Health Inc Medicare |
$589.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.93
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC CHANGE GASTROSTOMY TUBE - GASTROSTOMY TUBE, CHANGE / REPOSITION
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
7504376002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$412.00 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.00
|
|
|
HC CHANGE GASTROSTOMY TUBE - GASTROSTOMY TUBE, CHANGE / REPOSITION
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
7504376002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$288.40 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$453.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$412.00
|
| Rate for Payer: Aetna Government |
$412.00
|
| Rate for Payer: Brighton Health Commercial |
$618.00
|
| 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 |
$412.00
|
| Rate for Payer: Group Health Inc Commercial |
$412.00
|
| Rate for Payer: Group Health Inc Medicare |
$288.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$412.00
|
|
|
HC CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$824.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
7504376001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$288.40 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$453.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$412.00
|
| Rate for Payer: Aetna Government |
$412.00
|
| Rate for Payer: Brighton Health Commercial |
$618.00
|
| 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 |
$412.00
|
| Rate for Payer: Group Health Inc Commercial |
$412.00
|
| Rate for Payer: Group Health Inc Medicare |
$288.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$412.00
|
|
|
HC CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$824.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
7504376001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$412.00 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$412.00
|
|
|
HC CHANGE OF BLADDER TUBE,SIMPLE
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 51705 TC
|
| Hospital Charge Code |
3615170502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.54
|
| Rate for Payer: Aetna Government |
$110.54
|
| Rate for Payer: Brighton Health Commercial |
$533.25
|
| 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 |
$355.50
|
| Rate for Payer: Group Health Inc Commercial |
$355.50
|
| Rate for Payer: Group Health Inc Medicare |
$248.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC CHANGE OF BLADDER TUBE,SIMPLE
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 51705 TC
|
| Hospital Charge Code |
3615170502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC CHANGE URETERAL STENT VIA TRANSURETH
|
Facility
|
OP
|
$4,637.00
|
|
|
Service Code
|
CPT 50385
|
| Hospital Charge Code |
3615038501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.24 |
| Max. Negotiated Rate |
$3,477.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,477.75
|
| 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 |
$241.24
|
| 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 CHANGE URETERAL STENT VIA TRANSURETH
|
Facility
|
IP
|
$4,637.00
|
|
|
Service Code
|
CPT 50385
|
| Hospital Charge Code |
3615038501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,318.50 |
| Max. Negotiated Rate |
$2,318.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,318.50
|
|
|
HC CHANGE URETEROSTOMY TUBE/STENT
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
3615068801
|
|
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
|
|
