|
HC DESTROY VAG LESIONS, SIMPLE
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
5105706101
|
|
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 DESTR, PENIS LESION(S), EXTENSIVE
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 54065
|
| Hospital Charge Code |
3615406501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC DESTR, PENIS LESION(S), EXTENSIVE
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 54065
|
| Hospital Charge Code |
3615406501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$199.98 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$199.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC DESTRUCT BY NEURO AGENT; OTHER PERIPH NERVE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
3616464001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.70 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$1,844.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| 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 |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$1,087.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$1,087.77
|
| Rate for Payer: Group Health Inc Medicare |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$170.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC DESTRUCT BY NEURO AGENT; OTHER PERIPH NERVE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64640
|
| Hospital Charge Code |
3616464001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC DESTRUCT BY NEUROLYTIC AGENT - CELIAC PLEX
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64680 TC
|
| Hospital Charge Code |
3616468001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$190.47
|
| Rate for Payer: Aetna Government |
$190.47
|
| Rate for Payer: Brighton Health Commercial |
$1,844.25
|
| 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 |
$1,229.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,229.50
|
| Rate for Payer: Group Health Inc Medicare |
$860.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC DESTRUCT BY NEUROLYTIC AGENT - CELIAC PLEX
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64680 TC
|
| Hospital Charge Code |
3616468001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC DESTRUCTION ANAL LESION, EXTENSIVE
|
Facility
|
IP
|
$7,706.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
3614692401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,853.00 |
| Max. Negotiated Rate |
$3,853.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,853.00
|
|
|
HC DESTRUCTION ANAL LESION, EXTENSIVE
|
Facility
|
OP
|
$7,706.00
|
|
|
Service Code
|
CPT 46924
|
| Hospital Charge Code |
3614692401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$5,779.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,350.71
|
| Rate for Payer: Aetna Government |
$3,350.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,345.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,345.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,345.50
|
| Rate for Payer: Brighton Health Commercial |
$5,779.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,350.71
|
| 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 |
$3,350.71
|
| Rate for Payer: EmblemHealth Commercial |
$3,350.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,015.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,848.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,982.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,350.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,982.13
|
| Rate for Payer: Group Health Inc Commercial |
$3,350.71
|
| Rate for Payer: Group Health Inc Medicare |
$3,350.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,350.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,397.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,848.10
|
| Rate for Payer: Healthfirst QHP |
$3,350.71
|
| Rate for Payer: Humana Medicare |
$3,417.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,350.71
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,350.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,183.17
|
| Rate for Payer: Wellcare Medicare |
$3,183.17
|
|
|
HC DESTRUCTION BY NEUROLYTIC AGNT, GENICULAR NERVE BRANCHES W/ GUIDANCE
|
Facility
|
IP
|
$4,599.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
3616462401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,299.50 |
| Max. Negotiated Rate |
$2,299.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,299.50
|
|
|
HC DESTRUCTION BY NEUROLYTIC AGNT, GENICULAR NERVE BRANCHES W/ GUIDANCE
|
Facility
|
OP
|
$4,599.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
3616462401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.55 |
| Max. Negotiated Rate |
$3,449.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,385.93
|
| Rate for Payer: Aetna Government |
$2,385.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,670.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,670.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,670.15
|
| Rate for Payer: Brighton Health Commercial |
$3,449.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,385.93
|
| 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 |
$2,385.93
|
| Rate for Payer: EmblemHealth Commercial |
$2,385.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,147.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,028.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,123.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,385.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,123.48
|
| Rate for Payer: Group Health Inc Commercial |
$2,385.93
|
| Rate for Payer: Group Health Inc Medicare |
$2,385.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,385.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,028.04
|
| Rate for Payer: Healthfirst QHP |
$2,385.93
|
| Rate for Payer: Humana Medicare |
$2,433.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,385.93
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,385.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,385.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,266.63
|
| Rate for Payer: Wellcare Medicare |
$2,266.63
|
|
|
HC DESTRUCTION,LESION(S),VULVA;EXTENSIVE
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
5105651501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,346.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| 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 |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,346.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC DESTRUCTION,LESION(S),VULVA;EXTENSIVE
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
5105651501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC DESTRUCTION,LESION(S),VULVA,SIMPLE
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
5105650101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC DESTRUCTION,LESION(S),VULVA,SIMPLE
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
5105650101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.47 |
| Max. Negotiated Rate |
$2,346.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| 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 |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$155.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,346.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC DESTRUCTION OF EXTENSIVE RETINOPA
|
Facility
|
IP
|
$9,471.00
|
|
|
Service Code
|
CPT 67227
|
| Hospital Charge Code |
5106722701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,735.50 |
| Max. Negotiated Rate |
$4,735.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,735.50
|
|
|
HC DESTRUCTION OF EXTENSIVE RETINOPA
|
Facility
|
OP
|
$9,471.00
|
|
|
Service Code
|
CPT 67227
|
| Hospital Charge Code |
5106722701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.41 |
| Max. Negotiated Rate |
$4,837.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,607.48
|
| Rate for Payer: Aetna Government |
$4,607.48
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,225.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,225.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,225.24
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,607.48
|
| 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 |
$4,607.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,146.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,916.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,100.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,607.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,100.66
|
| 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 |
$4,607.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$284.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,916.36
|
| Rate for Payer: Healthfirst QHP |
$4,607.48
|
| Rate for Payer: Humana Medicare |
$4,699.63
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,837.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,607.48
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,607.48
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,607.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,377.11
|
| Rate for Payer: Wellcare Medicare |
$4,377.11
|
|
|
HC DESTRUCT RETINAL LESION
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 67208
|
| Hospital Charge Code |
5106720801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$644.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC DESTRUCT RETINAL LESION
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 67208
|
| Hospital Charge Code |
5106720801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - POCT INFLUENZA A
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
3068780402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.55
|
| Rate for Payer: Aetna Government |
$16.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.59
|
| Rate for Payer: Brighton Health Commercial |
$57.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.55
|
| Rate for Payer: EmblemHealth Commercial |
$16.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.73
|
| Rate for Payer: Group Health Inc Commercial |
$16.55
|
| Rate for Payer: Group Health Inc Medicare |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Healthfirst Essential Plan |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.55
|
| Rate for Payer: Healthfirst QHP |
$16.55
|
| Rate for Payer: Humana Medicare |
$16.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Wellcare Medicare |
$14.89
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - POCT INFLUENZA A
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
3068780402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - POCT INFLUENZA A/B
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
3068780403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.55
|
| Rate for Payer: Aetna Government |
$16.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.59
|
| Rate for Payer: Brighton Health Commercial |
$57.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.55
|
| Rate for Payer: EmblemHealth Commercial |
$16.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.73
|
| Rate for Payer: Group Health Inc Commercial |
$16.55
|
| Rate for Payer: Group Health Inc Medicare |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Healthfirst Essential Plan |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.55
|
| Rate for Payer: Healthfirst QHP |
$16.55
|
| Rate for Payer: Humana Medicare |
$16.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Wellcare Medicare |
$14.89
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - POCT INFLUENZA A/B
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
3068780403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
3068780401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.00
|
|
|
HC DETECT AGENT,IMMUN,DIR OBS,INFLUENZA - RAPID FLU
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
3068780401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.55
|
| Rate for Payer: Aetna Government |
$16.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.59
|
| Rate for Payer: Brighton Health Commercial |
$57.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.55
|
| Rate for Payer: EmblemHealth Commercial |
$16.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.73
|
| Rate for Payer: Group Health Inc Commercial |
$16.55
|
| Rate for Payer: Group Health Inc Medicare |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Healthfirst Essential Plan |
$32.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.55
|
| Rate for Payer: Healthfirst QHP |
$16.55
|
| Rate for Payer: Humana Medicare |
$16.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.65
|
| Rate for Payer: Wellcare Medicare |
$14.89
|
|
