|
HC COLPOCLEISIS
|
Facility
|
IP
|
$13,573.00
|
|
|
Service Code
|
CPT 57120
|
| Hospital Charge Code |
3615712001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,786.50 |
| Max. Negotiated Rate |
$6,786.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,786.50
|
|
|
HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
3615745401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.01 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$260.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$260.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$260.17
|
| Rate for Payer: Brighton Health Commercial |
$614.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| 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 |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$371.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.79
|
| Rate for Payer: Group Health Inc Commercial |
$371.67
|
| Rate for Payer: Group Health Inc Medicare |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$371.67
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$353.09
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC COLPOSC,CERVIX W/ADJ VAG,W/BX & CURRETAG
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 57454
|
| Hospital Charge Code |
3615745401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAGINA
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
3615745201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.79
|
| Rate for Payer: Aetna Government |
$245.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.05
|
| Rate for Payer: Brighton Health Commercial |
$355.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.79
|
| 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 |
$245.79
|
| Rate for Payer: EmblemHealth Commercial |
$245.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.75
|
| Rate for Payer: Group Health Inc Commercial |
$245.79
|
| Rate for Payer: Group Health Inc Medicare |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$105.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$245.79
|
| Rate for Payer: Humana Medicare |
$250.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.50
|
| Rate for Payer: Wellcare Medicare |
$233.50
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAGINA
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 57452
|
| Hospital Charge Code |
3615745201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.00
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
3615745601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$260.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$260.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$260.17
|
| Rate for Payer: Brighton Health Commercial |
$610.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| 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 |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$371.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.79
|
| Rate for Payer: Group Health Inc Commercial |
$371.67
|
| Rate for Payer: Group Health Inc Medicare |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$371.67
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$353.09
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAGINA, CURETTAG
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 57456
|
| Hospital Charge Code |
3615745601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
3615745501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.84 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$260.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$260.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$260.17
|
| Rate for Payer: Brighton Health Commercial |
$610.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| 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 |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$371.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.79
|
| Rate for Payer: Group Health Inc Commercial |
$371.67
|
| Rate for Payer: Group Health Inc Medicare |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$81.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$371.67
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$353.09
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAGINA,W/BX
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 57455
|
| Hospital Charge Code |
3615745501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
|
|
HC COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
3615746101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$204.75 |
| Max. Negotiated Rate |
$3,962.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$610.50
|
| 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 |
$204.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$211.85
|
| 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 COLPOSCOPY,CERVIX W/ADJ VAG,W/LOOP CONIZ
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
3615746101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
|
|
HC COLPOSCOPY,ENTIRE VAGINA
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
3615742001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$69.22 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$260.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$260.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$260.17
|
| Rate for Payer: Brighton Health Commercial |
$610.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| 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 |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$371.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.79
|
| Rate for Payer: Group Health Inc Commercial |
$371.67
|
| Rate for Payer: Group Health Inc Medicare |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$69.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$371.67
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$353.09
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC COLPOSCOPY,ENTIRE VAGINA
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
3615742001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
|
|
HC COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
3615742101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.28 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$1,449.75
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,063.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,063.89
|
| 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 |
$1,063.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$89.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.82
|
| 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: Senior Whole Health Medicare Advantage |
$1,063.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| 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 COLPOSCOPY,ENTIRE VAGINA,W/BIOPSY(S)
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 57421
|
| Hospital Charge Code |
3615742101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$966.50 |
| Max. Negotiated Rate |
$966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.50
|
|
|
HC COLPOSCOPY OF CERVIX, LOOP ELECTRODE BIOPSY
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
5105746001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC COLPOSCOPY OF CERVIX, LOOP ELECTRODE BIOPSY
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
5105746001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$4,079.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.62
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,079.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 COLPOSCOPY,VULVA
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
5105682001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC COLPOSCOPY,VULVA
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 56820
|
| Hospital Charge Code |
5105682001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.79
|
| Rate for Payer: Aetna Government |
$245.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.05
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.79
|
| 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 |
$245.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.75
|
| 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 |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$245.79
|
| Rate for Payer: Humana Medicare |
$250.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.50
|
| Rate for Payer: Wellcare Medicare |
$233.50
|
|
|
HC COLPOSCOPY,VULVA,W/BIOPSY(S)
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
5105682101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
|
|
HC COLPOSCOPY,VULVA,W/BIOPSY(S)
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 56821
|
| Hospital Charge Code |
5105682101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.39 |
| Max. Negotiated Rate |
$390.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$260.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$260.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$260.17
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| 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 |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.79
|
| 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 |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$85.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$131.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$371.67
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$353.09
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX - ENDO US (LOWER)
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 45391
|
| Hospital Charge Code |
7504539101
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,520.50 |
| Max. Negotiated Rate |
$1,520.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.50
|
|
|
HC COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX - ENDO US (LOWER)
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 45391
|
| Hospital Charge Code |
7504539101
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$287.55 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,440.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,440.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC COLUMN CHROMATOGHRAPHY NOS - BILE ACIDS, FRACTIONATED LCMS
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.09
|
| Rate for Payer: Aetna Government |
$24.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.86
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.86
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.86
|
| Rate for Payer: Brighton Health Commercial |
$45.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.09
|
| Rate for Payer: EmblemHealth Commercial |
$24.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.44
|
| Rate for Payer: Group Health Inc Commercial |
$24.09
|
| Rate for Payer: Group Health Inc Medicare |
$24.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.09
|
| Rate for Payer: Healthfirst QHP |
$24.09
|
| Rate for Payer: Humana Medicare |
$24.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare Commercial |
$22.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.89
|
| Rate for Payer: Wellcare Medicare |
$21.68
|
|
|
HC COLUMN CHROMATOGHRAPHY NOS - BILE ACIDS, FRACTIONATED LCMS
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3018254201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
