|
HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 49465 TC
|
| Hospital Charge Code |
7504946501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 49465 TC
|
| Hospital Charge Code |
3614946501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 49465 TC
|
| Hospital Charge Code |
3614946501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$186.37
|
| Rate for Payer: Aetna Government |
$186.37
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| 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 |
$352.50
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.28
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 49465 TC
|
| Hospital Charge Code |
7504946501
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$130.28 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$186.37
|
| Rate for Payer: Aetna Government |
$186.37
|
| Rate for Payer: Brighton Health Commercial |
$528.75
|
| 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 |
$352.50
|
| Rate for Payer: Group Health Inc Commercial |
$352.50
|
| Rate for Payer: Group Health Inc Medicare |
$246.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.28
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC CONTRAST XRAY THROAT/CERV ESOPHA - FL ESOPHAGUS PHARYNX
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 74210 TC
|
| Hospital Charge Code |
3207421001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.72
|
| Rate for Payer: Aetna Government |
$46.72
|
| Rate for Payer: Brighton Health Commercial |
$413.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.21
|
| Rate for Payer: EmblemHealth Commercial |
$68.33
|
| Rate for Payer: Group Health Inc Commercial |
$275.50
|
| Rate for Payer: Group Health Inc Medicare |
$192.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$68.33
|
| Rate for Payer: Healthfirst Essential Plan |
$114.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.79
|
|
|
HC CONTRAST XRAY THROAT/CERV ESOPHA - FL ESOPHAGUS PHARYNX
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74210 TC
|
| Hospital Charge Code |
3207421001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC CONTROL OROPHARYNGEAL HEM, SIMPLE
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
4504296001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC CONTROL OROPHARYNGEAL HEM, SIMPLE
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 42960
|
| Hospital Charge Code |
4504296001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$622.21
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$622.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI WITH DOUBLE CONT W/O KUB
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 74246 TC
|
| Hospital Charge Code |
3207424601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.39 |
| Max. Negotiated Rate |
$413.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.39
|
| Rate for Payer: Aetna Government |
$72.39
|
| Rate for Payer: Brighton Health Commercial |
$413.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$185.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$156.21
|
| Rate for Payer: EmblemHealth Commercial |
$99.07
|
| Rate for Payer: Group Health Inc Commercial |
$275.50
|
| Rate for Payer: Group Health Inc Medicare |
$192.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$99.07
|
| Rate for Payer: Healthfirst Essential Plan |
$212.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$94.24
|
|
|
HC CONTRST X-RAY UPPR GI TRACT - FL UPPER GI WITH DOUBLE CONT W/O KUB
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74246 TC
|
| Hospital Charge Code |
3207424601
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
3614944601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.14 |
| Max. Negotiated Rate |
$3,537.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,317.78
|
| Rate for Payer: Aetna Government |
$2,317.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,622.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,622.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,622.45
|
| Rate for Payer: Brighton Health Commercial |
$3,537.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,317.78
|
| 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 |
$2,317.78
|
| Rate for Payer: EmblemHealth Commercial |
$2,317.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,086.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,970.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,062.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,317.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,062.82
|
| Rate for Payer: Group Health Inc Commercial |
$2,317.78
|
| Rate for Payer: Group Health Inc Medicare |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,970.11
|
| Rate for Payer: Healthfirst QHP |
$2,317.78
|
| Rate for Payer: Humana Medicare |
$2,364.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,317.78
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,317.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,317.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,201.89
|
| Rate for Payer: Wellcare Medicare |
$2,201.89
|
|
|
HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
3614944601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,358.00 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
|
|
HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH
|
Facility
|
IP
|
$10,439.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
3614753501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,219.50 |
| Max. Negotiated Rate |
$5,219.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,219.50
|
|
|
HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH
|
Facility
|
OP
|
$10,439.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
3614753501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.21 |
| Max. Negotiated Rate |
$7,829.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,311.88
|
| Rate for Payer: Aetna Government |
$4,311.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,018.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,018.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,018.32
|
| Rate for Payer: Brighton Health Commercial |
$7,829.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,311.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,311.88
|
| Rate for Payer: EmblemHealth Commercial |
$4,311.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,880.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,665.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,837.57
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,311.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,837.57
|
| Rate for Payer: Group Health Inc Commercial |
$4,311.88
|
| Rate for Payer: Group Health Inc Medicare |
$4,311.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,311.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,685.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,665.10
|
| Rate for Payer: Healthfirst QHP |
$4,311.88
|
| Rate for Payer: Humana Medicare |
$4,398.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,311.88
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,311.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,311.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,096.29
|
| Rate for Payer: Wellcare Medicare |
$4,096.29
|
|
|
HC CORNEAL TOPOGRAPHY - CORNEAL TOPOGRAPHY - OD - RIGHT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
9209202501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC CORNEAL TOPOGRAPHY - CORNEAL TOPOGRAPHY - OD - RIGHT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
9209202501
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC CORNEAL TOPOGRAPHY - CORNEAL TOPOGRAPHY - OS - LEFT EYE
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
9209202502
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC CORNEAL TOPOGRAPHY - CORNEAL TOPOGRAPHY - OS - LEFT EYE
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
9209202502
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC CORNEAL TOPOGRAPHY - CORNEAL TOPOGRAPHY - OU - BOTH EYES
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
9209202503
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC CORNEAL TOPOGRAPHY - CORNEAL TOPOGRAPHY - OU - BOTH EYES
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
9209202503
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC CORONAVIRUS/COVID-19 TEST
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT U0002
|
| Hospital Charge Code |
309U000201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.00
|
|
|
HC CORONAVIRUS/COVID-19 TEST
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT U0002
|
| Hospital Charge Code |
309U000201
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$69.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna Government |
$51.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.92
|
| Rate for Payer: Brighton Health Commercial |
$39.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.31
|
| Rate for Payer: EmblemHealth Commercial |
$51.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.67
|
| Rate for Payer: Group Health Inc Commercial |
$51.31
|
| Rate for Payer: Group Health Inc Medicare |
$51.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.79
|
| Rate for Payer: Healthfirst Essential Plan |
$69.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$43.61
|
| Rate for Payer: Healthfirst QHP |
$51.31
|
| Rate for Payer: Humana Medicare |
$52.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.31
|
| Rate for Payer: United Healthcare Commercial |
$46.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.79
|
| Rate for Payer: Wellcare Medicare |
$46.18
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
3615443501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.65 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,214.02
|
| Rate for Payer: Aetna Government |
$4,214.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,949.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,949.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,949.81
|
| Rate for Payer: Brighton Health Commercial |
$6,856.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,214.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$4,214.02
|
| Rate for Payer: EmblemHealth Commercial |
$4,214.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,792.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,581.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,750.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,214.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,750.48
|
| Rate for Payer: Group Health Inc Commercial |
$4,214.02
|
| Rate for Payer: Group Health Inc Medicare |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,214.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,655.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$476.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,581.92
|
| Rate for Payer: Healthfirst QHP |
$4,214.02
|
| Rate for Payer: Humana Medicare |
$4,298.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,214.02
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,214.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,214.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,003.32
|
| Rate for Payer: Wellcare Medicare |
$4,003.32
|
|
|
HC CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 54435
|
| Hospital Charge Code |
3615443501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC CORTISOL, FREE - CORTISOL 24HR URINARY FREE
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
3018253001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$37.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.71
|
| Rate for Payer: Aetna Government |
$16.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.70
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.91
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.71
|
| Rate for Payer: EmblemHealth Commercial |
$16.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.87
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.87
|
| Rate for Payer: Group Health Inc Commercial |
$16.71
|
| Rate for Payer: Group Health Inc Medicare |
$16.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.71
|
| Rate for Payer: Healthfirst Essential Plan |
$37.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.71
|
| Rate for Payer: Healthfirst QHP |
$16.71
|
| Rate for Payer: Humana Medicare |
$17.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare Commercial |
$21.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.71
|
| Rate for Payer: Wellcare Medicare |
$15.04
|
|
