|
HC CHANGE URETEROSTOMY TUBE/STENT
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
3615068801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.97 |
| Max. Negotiated Rate |
$4,023.75 |
| 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 |
$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 |
$88.97
|
| 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 |
$1,409.00
|
| 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 URETER STENT, PERCUT
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 50382 TC
|
| Hospital Charge Code |
3615038201
|
|
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 CHANGE URETER STENT, PERCUT
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 50382 TC
|
| Hospital Charge Code |
3615038201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$959.88 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,457.81
|
| Rate for Payer: Aetna Government |
$1,457.81
|
| Rate for Payer: Brighton Health Commercial |
$4,023.75
|
| 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 |
$2,682.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,682.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,877.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC CHEM CAUTERY GRANULATN TISSUE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
3611725002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC CHEM CAUTERY GRANULATN TISSUE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
3611725002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC CHEM CAUT OF GRANULATION TISSUE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
3611725001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC CHEM CAUT OF GRANULATION TISSUE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
3611725001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC CHEMICAL PEEL, FACIAL, EPIDERMAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 15788
|
| Hospital Charge Code |
5101578801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC CHEMICAL PEEL, FACIAL, EPIDERMAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 15788
|
| Hospital Charge Code |
5101578801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$512.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| 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 |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| 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 |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$512.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC CHEMICAL PLEURODESIS FOR PERSISTENT PNEUMOTHORAX
|
Facility
|
OP
|
$1,735.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
3613256001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$85.51 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$755.40
|
| Rate for Payer: Aetna Government |
$755.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$528.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$528.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$528.78
|
| Rate for Payer: Brighton Health Commercial |
$1,301.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$755.40
|
| 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 |
$755.40
|
| Rate for Payer: EmblemHealth Commercial |
$755.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$679.86
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$642.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$672.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$755.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$672.31
|
| Rate for Payer: Group Health Inc Commercial |
$755.40
|
| Rate for Payer: Group Health Inc Medicare |
$755.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$755.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$755.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$642.09
|
| Rate for Payer: Healthfirst QHP |
$755.40
|
| Rate for Payer: Humana Medicare |
$770.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$755.40
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$755.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$755.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$717.63
|
| Rate for Payer: Wellcare Medicare |
$717.63
|
|
|
HC CHEMICAL PLEURODESIS FOR PERSISTENT PNEUMOTHORAX
|
Facility
|
IP
|
$1,735.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
3613256001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.50 |
| Max. Negotiated Rate |
$867.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$867.50
|
|
|
HC CHEMILUMINESCENT ASSAY - ANIT-MULLERIAN HORMONE (AMH)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3018239702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.88
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.12
|
| Rate for Payer: EmblemHealth Commercial |
$14.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.57
|
| Rate for Payer: Group Health Inc Commercial |
$14.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.12
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$17.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.41
|
| Rate for Payer: Wellcare Medicare |
$12.71
|
|
|
HC CHEMILUMINESCENT ASSAY - ANIT-MULLERIAN HORMONE (AMH)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3018239702
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC CHEMILUMINESCENT ASSAY - PTHRP (PTH-RELATED PEPTIDE)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3018239701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.88
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.12
|
| Rate for Payer: EmblemHealth Commercial |
$14.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.57
|
| Rate for Payer: Group Health Inc Commercial |
$14.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.12
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$17.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.41
|
| Rate for Payer: Wellcare Medicare |
$12.71
|
|
|
HC CHEMILUMINESCENT ASSAY - PTHRP (PTH-RELATED PEPTIDE)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3018239701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC CHEMILUMINESCENT ASSAY - TSH RECEPTOR ANTIBODY
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3018239703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.12
|
| Rate for Payer: Aetna Government |
$14.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.88
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.21
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.12
|
| Rate for Payer: EmblemHealth Commercial |
$14.12
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.57
|
| Rate for Payer: Group Health Inc Commercial |
$14.12
|
| Rate for Payer: Group Health Inc Medicare |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.12
|
| Rate for Payer: Healthfirst QHP |
$14.12
|
| Rate for Payer: Humana Medicare |
$14.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.12
|
| Rate for Payer: United Healthcare Commercial |
$17.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.41
|
| Rate for Payer: Wellcare Medicare |
$12.71
|
|
|
HC CHEMILUMINESCENT ASSAY - TSH RECEPTOR ANTIBODY
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
3018239703
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC CHEMO ADMIN BOTH INFUSION & OTHER
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT Q0085
|
| Hospital Charge Code |
335Q008501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$134.78 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$215.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.78
|
| Rate for Payer: Aetna Government |
$134.78
|
| Rate for Payer: Brighton Health Commercial |
$293.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: EmblemHealth Commercial |
$195.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$195.50
|
| Rate for Payer: Group Health Inc Medicare |
$136.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$195.50
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
HC CHEMO ADMIN BOTH INFUSION & OTHER
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT Q0085
|
| Hospital Charge Code |
335Q008501
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$195.50 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$195.50
|
|
|
HC CHEMO ADMIN BY INFUSION ONLY
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT Q0084
|
| Hospital Charge Code |
335Q008401
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.00
|
|
|
HC CHEMO ADMIN BY INFUSION ONLY
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT Q0084
|
| Hospital Charge Code |
335Q008401
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$136.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.12
|
| Rate for Payer: Aetna Government |
$100.12
|
| Rate for Payer: Brighton Health Commercial |
$186.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: EmblemHealth Commercial |
$124.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$124.00
|
| Rate for Payer: Group Health Inc Medicare |
$86.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$124.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.00
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
HC CHEMO ADMIN BY OTHER THAN INFUSION
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT Q0083
|
| Hospital Charge Code |
331Q008301
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
|
|
HC CHEMO ADMIN BY OTHER THAN INFUSION
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT Q0083
|
| Hospital Charge Code |
331Q008301
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$173.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74.20
|
| Rate for Payer: Aetna Government |
$74.20
|
| Rate for Payer: Brighton Health Commercial |
$236.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: EmblemHealth Commercial |
$157.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$157.50
|
| Rate for Payer: Group Health Inc Medicare |
$110.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.50
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
|
|
HC CHEMODENERV TRUNK 1-5 MUSCLES
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
5106464601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.78 |
| Max. Negotiated Rate |
$888.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| 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 |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| 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 |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$140.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$888.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC CHEMODENERV TRUNK 1-5 MUSCLES
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
5106464601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$946.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.50
|
|
