|
HC COMPLETE CBC W/ MANUAL DIFF WBC
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 85007
|
| Hospital Charge Code |
3058500701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC COMPLETE CBC W/O DIFFERENTIAL
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
|
HC COMPLETE CBC W/O DIFFERENTIAL
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
3058502701
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.47
|
| Rate for Payer: Aetna Government |
$6.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.53
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.47
|
| Rate for Payer: EmblemHealth Commercial |
$6.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.76
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.76
|
| Rate for Payer: Group Health Inc Commercial |
$6.47
|
| Rate for Payer: Group Health Inc Medicare |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Healthfirst Essential Plan |
$7.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.47
|
| Rate for Payer: Healthfirst QHP |
$6.47
|
| Rate for Payer: Humana Medicare |
$6.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.47
|
| Rate for Payer: United Healthcare Commercial |
$8.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
5105172601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.70 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$297.16
|
| Rate for Payer: Aetna Government |
$297.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$208.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.16
|
| 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 |
$297.16
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.47
|
| 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 |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$319.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.59
|
| Rate for Payer: Healthfirst QHP |
$297.16
|
| Rate for Payer: Humana Medicare |
$303.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.16
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$282.30
|
| Rate for Payer: Wellcare Medicare |
$282.30
|
|
|
HC COMPLEX CYSTOMETROGRAM
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 51726
|
| Hospital Charge Code |
5105172601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC COMPLEX CYSTOMETROGRAM W/VPS
|
Facility
|
IP
|
$1,770.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
5105172801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$885.00 |
| Max. Negotiated Rate |
$885.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$885.00
|
|
|
HC COMPLEX CYSTOMETROGRAM W/VPS
|
Facility
|
OP
|
$1,770.00
|
|
|
Service Code
|
CPT 51728
|
| Hospital Charge Code |
5105172801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$856.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$815.53
|
| Rate for Payer: Aetna Government |
$815.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$570.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$570.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$570.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$815.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$815.53
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$733.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$693.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$725.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$815.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$725.82
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$815.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$229.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$389.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$693.20
|
| Rate for Payer: Healthfirst QHP |
$815.53
|
| Rate for Payer: Humana Medicare |
$831.84
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$856.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$815.53
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$815.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$815.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$774.75
|
| Rate for Payer: Wellcare Medicare |
$774.75
|
|
|
HC COMPLEX CYSTOMETROGRAM W/VPS&UPP
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 51729 TC
|
| Hospital Charge Code |
5105172901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$260.53
|
| Rate for Payer: Aetna Government |
$260.53
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$273.57
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC COMPLEX CYSTOMETROGRAM W/VPS&UPP
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 51729 TC
|
| Hospital Charge Code |
5105172901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$850.50 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.50
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
OP
|
$7,023.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
3611018002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.07 |
| Max. Negotiated Rate |
$5,267.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,496.91
|
| Rate for Payer: Aetna Government |
$3,496.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,447.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,447.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,447.84
|
| Rate for Payer: Brighton Health Commercial |
$5,267.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,496.91
|
| 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 |
$3,496.91
|
| Rate for Payer: EmblemHealth Commercial |
$3,496.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,147.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,972.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,112.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,496.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,112.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,496.91
|
| Rate for Payer: Group Health Inc Medicare |
$3,496.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,496.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,972.37
|
| Rate for Payer: Healthfirst QHP |
$3,496.91
|
| Rate for Payer: Humana Medicare |
$3,566.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,496.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,496.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,496.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,322.06
|
| Rate for Payer: Wellcare Medicare |
$3,322.06
|
|
|
HC COMPLEX DRAINAGE, WOUND
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
3611018002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,511.50 |
| Max. Negotiated Rate |
$3,511.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.50
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
IP
|
$421.00
|
|
|
Service Code
|
CPT 51741 TC
|
| Hospital Charge Code |
5105174101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$210.50 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
|
|
HC COMPLEX UROFLOWMETRY
|
Facility
|
OP
|
$421.00
|
|
|
Service Code
|
CPT 51741 TC
|
| Hospital Charge Code |
5105174101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.36
|
| Rate for Payer: Aetna Government |
$9.36
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$210.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.22
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
4719255701
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.71 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC COMPREHENSIVE HEARING TEST
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 92557
|
| Hospital Charge Code |
4719255701
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC COMPREHENSIVE REVIEW OF DATA PRO - LAB COMPREHENSIVE REVIEW OF DATA
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 88325 TC
|
| Hospital Charge Code |
3128832501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$154.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$106.96
|
| Rate for Payer: Aetna Government |
$106.96
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$154.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.87
|
| Rate for Payer: EmblemHealth Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Medicare |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
|
HC COMPREHENSIVE REVIEW OF DATA PRO - LAB COMPREHENSIVE REVIEW OF DATA
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 88325 TC
|
| Hospital Charge Code |
3128832501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC COMPR MEDICATION SVCS, PER 15 MIN
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT H2010
|
| Hospital Charge Code |
911H201001
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$215.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37.85
|
| Rate for Payer: Aetna Government |
$37.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$215.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$215.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$95.77
|
| Rate for Payer: Amida Care Medicaid |
$95.77
|
| Rate for Payer: Brighton Health Commercial |
$187.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$200.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$170.00
|
| Rate for Payer: EmblemHealth Commercial |
$125.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$215.47
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$95.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$95.77
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$215.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$215.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.55
|
| Rate for Payer: Group Health Inc Commercial |
$125.00
|
| Rate for Payer: Group Health Inc Medicare |
$87.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$95.77
|
| Rate for Payer: Healthfirst Essential Plan |
$215.47
|
| Rate for Payer: Healthfirst QHP |
$156.10
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$95.77
|
| Rate for Payer: SOMOS Essential |
$215.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$215.47
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$105.34
|
| Rate for Payer: United Healthcare Medicaid |
$95.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$95.77
|
|
|
HC COMPR MEDICATION SVCS, PER 15 MIN
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT H2010
|
| Hospital Charge Code |
911H201001
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC COMP WND REP, EYELID/NOSE/EAR/LIP, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
3611315101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$317.81 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| 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 |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$317.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, EYELID/NOSE/EAR/LIP, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
3611315101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC COMP WND REP, EYELID/NOSE/EAR/LIP, 2.6-7.5CM
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
3611315201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC COMP WND REP, EYELID/NOSE/EAR/LIP, 2.6-7.5CM
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
3611315201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| 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 |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$380.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, EYELID/NOSE/EAR/LIP, EACH ADD'L 5CM/< (ADDON)
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
3611315301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$123.56 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$123.56
|
| Rate for Payer: Aetna Government |
$123.56
|
| Rate for Payer: Brighton Health Commercial |
$426.75
|
| 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 |
$284.50
|
| Rate for Payer: Group Health Inc Commercial |
$284.50
|
| Rate for Payer: Group Health Inc Medicare |
$199.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$284.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC COMP WND REP, EYELID/NOSE/EAR/LIP, EACH ADD'L 5CM/< (ADDON)
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
3611315301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$284.50 |
| Max. Negotiated Rate |
$284.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$284.50
|
|
