|
HC DEVEL TST PHYS/QHP 1ST HR
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
9189611201
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC DEVEL TST PHYS/QHP ADD'L 30MINS
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
9189611301
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$239.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$92.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Government |
$50.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.41
|
| Rate for Payer: Amida Care Medicaid |
$106.41
|
| Rate for Payer: Brighton Health Commercial |
$126.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$106.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$135.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$114.92
|
| Rate for Payer: EmblemHealth Commercial |
$84.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$239.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$106.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.73
|
| Rate for Payer: Group Health Inc Commercial |
$84.50
|
| Rate for Payer: Group Health Inc Medicare |
$59.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.41
|
| Rate for Payer: Healthfirst Essential Plan |
$239.43
|
| Rate for Payer: Healthfirst QHP |
$173.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.43
|
| Rate for Payer: Optum Medicaid |
$0.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: SOMOS Essential |
$239.43
|
| Rate for Payer: United Healthcare Commercial |
$84.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$239.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$117.05
|
| Rate for Payer: United Healthcare Medicaid |
$106.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.41
|
|
|
HC DEVEL TST PHYS/QHP ADD'L 30MINS
|
Facility
|
IP
|
$169.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
9189611301
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$84.50 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$84.50
|
|
|
HC DEXAMETHASONE SUPPRESSION PANEL,48HR
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 80420
|
| Hospital Charge Code |
3018042001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$117.00
|
|
|
HC DEXAMETHASONE SUPPRESSION PANEL,48HR
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 80420
|
| Hospital Charge Code |
3018042001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.45 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$128.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.88
|
| Rate for Payer: Aetna Government |
$161.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$113.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$113.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$113.32
|
| Rate for Payer: Brighton Health Commercial |
$175.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$161.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$102.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$161.88
|
| Rate for Payer: EmblemHealth Commercial |
$161.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$145.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$137.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$144.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$161.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$144.07
|
| Rate for Payer: Group Health Inc Commercial |
$161.88
|
| Rate for Payer: Group Health Inc Medicare |
$161.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$161.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$161.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.45
|
| Rate for Payer: Healthfirst Essential Plan |
$147.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$161.88
|
| Rate for Payer: Healthfirst QHP |
$161.88
|
| Rate for Payer: Humana Medicare |
$165.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$161.88
|
| Rate for Payer: United Healthcare Commercial |
$91.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$161.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$65.45
|
| Rate for Payer: Wellcare Medicare |
$145.69
|
|
|
HC DIAB SLF MGMT GROUP 30 MIN
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
942G010901
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.43
|
| Rate for Payer: Aetna Government |
$8.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22.45
|
| Rate for Payer: Amida Care Medicaid |
$22.45
|
| Rate for Payer: Brighton Health Commercial |
$33.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.51
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.57
|
| 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 |
$22.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.45
|
| Rate for Payer: Healthfirst Essential Plan |
$50.51
|
| Rate for Payer: Healthfirst QHP |
$36.59
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.45
|
| Rate for Payer: SOMOS Essential |
$50.51
|
| Rate for Payer: United Healthcare Commercial |
$22.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$24.69
|
| Rate for Payer: United Healthcare Medicaid |
$22.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.45
|
|
|
HC DIAB SLF MGMT GROUP 30 MIN
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
942G010901
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC DIAB SLF MGMT INDIVID 30 MIN
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
942G010801
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$88.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.61
|
| Rate for Payer: Aetna Government |
$31.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$100.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$100.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$44.87
|
| Rate for Payer: Amida Care Medicaid |
$44.87
|
| Rate for Payer: Brighton Health Commercial |
$120.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$128.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$109.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$100.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$44.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$44.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$100.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.97
|
| Rate for Payer: Fidelis Qualified Health Plan |
$47.12
|
| 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 |
$44.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.87
|
| Rate for Payer: Healthfirst Essential Plan |
$100.97
|
| Rate for Payer: Healthfirst QHP |
$73.14
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$44.87
|
| Rate for Payer: SOMOS Essential |
$100.97
|
| Rate for Payer: United Healthcare Commercial |
$80.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$100.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$49.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$44.87
|
|
|
HC DIAB SLF MGMT INDIVID 30 MIN
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
942G010801
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$80.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$80.50
|
|
|
HC DIAG BONE MARROW ASPIRATION
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
3613822001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC DIAG BONE MARROW ASPIRATION
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 38220
|
| Hospital Charge Code |
3613822001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.08 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$75.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC DIAGNOSTIC AMNIOCENTESIS
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
5105900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.16 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,063.89
|
| Rate for Payer: Aetna Government |
$1,063.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$744.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$744.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$744.72
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,063.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,063.89
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$957.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$904.31
|
| Rate for Payer: Fidelis Essential Plan QHP |
$946.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,063.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$946.86
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.23
|
| Rate for Payer: Healthfirst Medicare Advantage |
$904.31
|
| Rate for Payer: Healthfirst QHP |
$1,063.89
|
| Rate for Payer: Humana Medicare |
$1,085.17
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,117.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,063.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,063.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,063.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,010.70
|
| Rate for Payer: Wellcare Medicare |
$1,010.70
|
|
|
HC DIAGNOSTIC AMNIOCENTESIS
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
5105900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$966.50 |
| Max. Negotiated Rate |
$966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.50
|
|
|
HC DIAGNOSTIC ANOSCOPY & BIOPSY
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 46607
|
| Hospital Charge Code |
3614660701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,520.50 |
| Max. Negotiated Rate |
$1,520.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.50
|
|
|
HC DIAGNOSTIC ANOSCOPY & BIOPSY
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 46607
|
| Hospital Charge Code |
3614660701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.07 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$2,280.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$1,440.62
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| Rate for Payer: Group Health Inc Commercial |
$1,440.62
|
| Rate for Payer: Group Health Inc Medicare |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC DIAGNOSTIC SIGMOIDOSCOPY
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
7504533001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,156.50 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.50
|
|
|
HC DIAGNOSTIC SIGMOIDOSCOPY
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
7504533001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$65.70 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,113.95
|
| Rate for Payer: Aetna Government |
$1,113.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$779.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$779.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$779.76
|
| Rate for Payer: Brighton Health Commercial |
$1,734.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.95
|
| 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 |
$1,113.95
|
| Rate for Payer: EmblemHealth Commercial |
$1,113.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.42
|
| Rate for Payer: Group Health Inc Commercial |
$1,113.95
|
| Rate for Payer: Group Health Inc Medicare |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$65.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.86
|
| Rate for Payer: Healthfirst QHP |
$1,113.95
|
| Rate for Payer: Humana Medicare |
$1,136.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,058.25
|
| Rate for Payer: Wellcare Medicare |
$1,058.25
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - CAPD
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8419094501
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - CAPD
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8419094501
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$798.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$520.28
|
| Rate for Payer: Aetna Government |
$520.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$304.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$304.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.41
|
| Rate for Payer: Amida Care Medicaid |
$135.41
|
| Rate for Payer: Brighton Health Commercial |
$798.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$520.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$657.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$559.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$520.28
|
| Rate for Payer: EmblemHealth Commercial |
$650.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$304.67
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$135.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$520.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$520.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Healthfirst Essential Plan |
$304.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.24
|
| Rate for Payer: Healthfirst QHP |
$220.72
|
| Rate for Payer: Humana Medicare |
$530.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$520.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.41
|
| Rate for Payer: SOMOS Essential |
$304.67
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$304.67
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148.95
|
| Rate for Payer: United Healthcare Medicaid |
$135.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Wellcare Medicare |
$370.00
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - CCPD
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8519094501
|
|
Hospital Revenue Code
|
851
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - CCPD
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8519094501
|
|
Hospital Revenue Code
|
851
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$798.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$520.28
|
| Rate for Payer: Aetna Government |
$520.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$304.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$304.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.41
|
| Rate for Payer: Amida Care Medicaid |
$135.41
|
| Rate for Payer: Brighton Health Commercial |
$798.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$520.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$657.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$559.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$520.28
|
| Rate for Payer: EmblemHealth Commercial |
$650.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$304.67
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$135.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$520.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$520.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Healthfirst Essential Plan |
$304.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.24
|
| Rate for Payer: Healthfirst QHP |
$220.72
|
| Rate for Payer: Humana Medicare |
$530.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$520.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.41
|
| Rate for Payer: SOMOS Essential |
$304.67
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$304.67
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148.95
|
| Rate for Payer: United Healthcare Medicaid |
$135.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Wellcare Medicare |
$370.00
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - MISCELLANEOUS DIALYSIS
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8819094501
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$520.28
|
| Rate for Payer: Aetna Government |
$520.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$304.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$304.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.41
|
| Rate for Payer: Amida Care Medicaid |
$135.41
|
| Rate for Payer: Brighton Health Commercial |
$798.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$520.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$852.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$724.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$520.28
|
| Rate for Payer: EmblemHealth Commercial |
$650.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$304.67
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$135.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$135.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$304.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$304.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$520.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$142.18
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$520.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Healthfirst Essential Plan |
$304.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.24
|
| Rate for Payer: Healthfirst QHP |
$220.72
|
| Rate for Payer: Humana Medicare |
$530.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$520.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.41
|
| Rate for Payer: SOMOS Essential |
$304.67
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$304.67
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148.95
|
| Rate for Payer: United Healthcare Medicaid |
$135.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Wellcare Medicare |
$494.27
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - MISCELLANEOUS DIALYSIS
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8819094501
|
|
Hospital Revenue Code
|
881
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - PERITONEAL DIALYSIS
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8319094501
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$798.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$585.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$520.28
|
| Rate for Payer: Aetna Government |
$520.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$304.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$304.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.41
|
| Rate for Payer: Amida Care Medicaid |
$135.41
|
| Rate for Payer: Brighton Health Commercial |
$798.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$520.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$657.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$559.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$520.28
|
| Rate for Payer: EmblemHealth Commercial |
$650.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$304.67
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$135.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$150.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$159.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$520.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$158.00
|
| Rate for Payer: Group Health Inc Commercial |
$650.00
|
| Rate for Payer: Group Health Inc Medicare |
$435.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$135.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$520.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Healthfirst Essential Plan |
$304.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$442.24
|
| Rate for Payer: Healthfirst QHP |
$220.72
|
| Rate for Payer: Humana Medicare |
$530.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$520.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$135.41
|
| Rate for Payer: SOMOS Essential |
$304.67
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$304.67
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$148.95
|
| Rate for Payer: United Healthcare Medicaid |
$135.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$520.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$135.41
|
| Rate for Payer: Wellcare Medicare |
$370.00
|
|
|
HC DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL - PERITONEAL DIALYSIS
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
8319094501
|
|
Hospital Revenue Code
|
831
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$532.50
|
|
