|
HC CRITICAL CARE, ADDL 30 MIN
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 99292
|
| Hospital Charge Code |
6819929201
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$249.50 |
| Max. Negotiated Rate |
$249.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$249.50
|
|
|
HC CRITICAL CARE, E/M 30-74 MINUTES
|
Facility
|
IP
|
$2,019.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
6819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,009.50 |
| Max. Negotiated Rate |
$1,009.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,009.50
|
|
|
HC CRITICAL CARE, E/M 30-74 MINUTES
|
Facility
|
OP
|
$2,019.00
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
6819929101
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$237.34 |
| Max. Negotiated Rate |
$1,615.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,110.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,029.52
|
| Rate for Payer: Aetna Government |
$1,029.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$720.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$720.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$720.66
|
| Rate for Payer: Brighton Health Commercial |
$1,514.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,029.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,615.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,372.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,029.52
|
| Rate for Payer: EmblemHealth Commercial |
$1,029.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$926.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$875.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$916.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,029.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$916.27
|
| Rate for Payer: Group Health Inc Commercial |
$1,029.52
|
| Rate for Payer: Group Health Inc Medicare |
$1,029.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,029.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,029.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$875.09
|
| Rate for Payer: Healthfirst QHP |
$1,029.52
|
| Rate for Payer: Humana Medicare |
$1,050.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,029.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,029.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,029.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$978.04
|
| Rate for Payer: Wellcare Medicare |
$978.04
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC CRYOCAUTERY OF CERVIX
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 57511
|
| Hospital Charge Code |
5105751101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.39 |
| 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 |
$118.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$171.80
|
| 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 CRYOPRECIPITATE, EACH UNIT
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
387P901201
|
|
Hospital Revenue Code
|
387
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
|
|
HC CRYOPRECIPITATE, EACH UNIT
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
387P901201
|
|
Hospital Revenue Code
|
387
|
| Min. Negotiated Rate |
$54.37 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.67
|
| Rate for Payer: Aetna Government |
$77.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$54.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$54.37
|
| Rate for Payer: Brighton Health Commercial |
$77.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$476.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$77.67
|
| Rate for Payer: EmblemHealth Commercial |
$77.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.13
|
| Rate for Payer: Group Health Inc Commercial |
$77.67
|
| Rate for Payer: Group Health Inc Medicare |
$77.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.02
|
| Rate for Payer: Healthfirst QHP |
$77.67
|
| Rate for Payer: Humana Medicare |
$79.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.67
|
| Rate for Payer: United Healthcare Commercial |
$350.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$69.90
|
|
|
HC CRYOPRECIPITATE POOLED, EACH UNIT
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
387P901202
|
|
Hospital Revenue Code
|
387
|
| Min. Negotiated Rate |
$54.37 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.67
|
| Rate for Payer: Aetna Government |
$77.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$54.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$54.37
|
| Rate for Payer: Brighton Health Commercial |
$77.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$77.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$77.67
|
| Rate for Payer: EmblemHealth Commercial |
$77.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$69.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$66.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$69.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$77.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$69.13
|
| Rate for Payer: Group Health Inc Commercial |
$77.67
|
| Rate for Payer: Group Health Inc Medicare |
$77.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$66.02
|
| Rate for Payer: Healthfirst QHP |
$77.67
|
| Rate for Payer: Humana Medicare |
$79.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$77.67
|
| Rate for Payer: United Healthcare Commercial |
$87.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$77.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$69.90
|
|
|
HC CRYOPRECIPITATE POOLED, EACH UNIT
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
387P901202
|
|
Hospital Revenue Code
|
387
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
|
|
HC CRYOSURGERY
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
3611734001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.81 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$72.75
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$55.92
|
| 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 |
$1,113.00
|
| 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 CRYOSURGERY
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 17340
|
| Hospital Charge Code |
3611734001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$48.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$48.50
|
|
|
HC C-SECTION L&D CHARGE
|
Facility
|
IP
|
$2,500.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
7205951401
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$1,250.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
|
|
HC C-SECTION L&D CHARGE
|
Facility
|
OP
|
$2,500.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
7205951401
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$875.00 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,375.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,111.54
|
| Rate for Payer: Aetna Government |
$1,111.54
|
| Rate for Payer: Brighton Health Commercial |
$1,875.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,700.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,250.00
|
| Rate for Payer: Group Health Inc Medicare |
$875.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,250.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,094.98
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
HC CSF FLUID SCAN CISTERNOGRAPHY - NM BRAIN CISTERNOGRAM
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78630 TC
|
| Hospital Charge Code |
3407863001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$209.14 |
| Max. Negotiated Rate |
$1,276.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.14
|
| Rate for Payer: Aetna Government |
$209.14
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,276.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,074.06
|
| Rate for Payer: EmblemHealth Commercial |
$284.00
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.00
|
| Rate for Payer: Healthfirst Essential Plan |
$490.30
|
| Rate for Payer: United Healthcare Commercial |
$477.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$217.91
|
|
|
HC CSF FLUID SCAN CISTERNOGRAPHY - NM BRAIN CISTERNOGRAM
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78630 TC
|
| Hospital Charge Code |
3407863001
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC CSF SHUNT EVALUATION - NM SHUNT PATENCY
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78645 TC
|
| Hospital Charge Code |
3407864501
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC CSF SHUNT EVALUATION - NM SHUNT PATENCY
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78645 TC
|
| Hospital Charge Code |
3407864501
|
|
Hospital Revenue Code
|
340
|
| Min. Negotiated Rate |
$188.46 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$202.35
|
| Rate for Payer: Aetna Government |
$202.35
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$514.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$432.72
|
| Rate for Payer: EmblemHealth Commercial |
$277.71
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.71
|
| Rate for Payer: Healthfirst Essential Plan |
$424.04
|
| Rate for Payer: United Healthcare Commercial |
$192.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$188.46
|
|
|
HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
3527416001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC CT ABDOMEN W/DYE - CT ABDOMEN W CONTRAST
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 74160 TC
|
| Hospital Charge Code |
3527416001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$641.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$174.00
|
| Rate for Payer: Aetna Government |
$174.00
|
| Rate for Payer: Brighton Health Commercial |
$413.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$641.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$540.04
|
| Rate for Payer: EmblemHealth Commercial |
$183.12
|
| 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 |
$183.12
|
| Rate for Payer: Healthfirst Essential Plan |
$487.01
|
| Rate for Payer: United Healthcare Commercial |
$239.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$216.45
|
|
|
HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
3527415001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$86.84 |
| Max. Negotiated Rate |
$414.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$93.61
|
| Rate for Payer: Aetna Government |
$93.61
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$414.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$349.19
|
| Rate for Payer: EmblemHealth Commercial |
$86.84
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$86.84
|
| Rate for Payer: Healthfirst Essential Plan |
$359.37
|
| Rate for Payer: United Healthcare Commercial |
$155.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$159.72
|
|
|
HC CT ABDOMEN W/O DYE - CT ABDOMEN WO CONTRAST
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 74150 TC
|
| Hospital Charge Code |
3527415001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
3527417001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$192.85 |
| Max. Negotiated Rate |
$715.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$303.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$200.43
|
| Rate for Payer: Aetna Government |
$200.43
|
| Rate for Payer: Brighton Health Commercial |
$413.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$715.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$602.07
|
| Rate for Payer: EmblemHealth Commercial |
$207.58
|
| 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 |
$207.58
|
| Rate for Payer: Healthfirst Essential Plan |
$713.97
|
| Rate for Payer: United Healthcare Commercial |
$267.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$317.32
|
|
|
HC CT ABDOMEN W/O & W/DYE - CT ABDOMEN W WO CONTRAST
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74170 TC
|
| Hospital Charge Code |
3527417001
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3527417801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
|
|
HC CT ABD & PELV 1/> REGNS - CT ABDOMEN PELVIS W WO CONTRAST
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 74178 TC
|
| Hospital Charge Code |
3527417801
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$261.23 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$635.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$263.15
|
| Rate for Payer: Aetna Government |
$263.15
|
| Rate for Payer: Brighton Health Commercial |
$867.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$715.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$602.07
|
| Rate for Payer: EmblemHealth Commercial |
$261.23
|
| Rate for Payer: Group Health Inc Commercial |
$578.00
|
| Rate for Payer: Group Health Inc Medicare |
$404.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$261.23
|
| Rate for Payer: Healthfirst Essential Plan |
$588.13
|
| Rate for Payer: United Healthcare Commercial |
$267.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$261.39
|
|
