|
HC DIAPHRAGM/CERVICAL CAP FIT
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
5105717001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC DIAPHRAGM/CERVICAL CAP FIT
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 57170
|
| Hospital Charge Code |
5105717001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.79
|
| Rate for Payer: Aetna Government |
$245.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.05
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.79
|
| 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 |
$245.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.75
|
| 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 |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$245.79
|
| Rate for Payer: Humana Medicare |
$250.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.50
|
| Rate for Payer: Wellcare Medicare |
$233.50
|
|
|
HC DIFFUSING CAPACITY - CARBON MONOXIDE DIFFUSING CAPACITY
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$86.50 |
| Max. Negotiated Rate |
$86.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.50
|
|
|
HC DIFFUSING CAPACITY - CARBON MONOXIDE DIFFUSING CAPACITY
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
4609472901
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$48.67 |
| Max. Negotiated Rate |
$138.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$95.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.67
|
| Rate for Payer: Aetna Government |
$48.67
|
| Rate for Payer: Brighton Health Commercial |
$129.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$138.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$117.64
|
| Rate for Payer: EmblemHealth Commercial |
$86.50
|
| Rate for Payer: Group Health Inc Commercial |
$86.50
|
| Rate for Payer: Group Health Inc Medicare |
$60.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.84
|
| Rate for Payer: United Healthcare Commercial |
$86.50
|
|
|
HC DILATE ESOPHAGUS - ESOPHAGEAL DILATION
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
7504345001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,237.50
|
|
|
HC DILATE ESOPHAGUS - ESOPHAGEAL DILATION
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT 43450
|
| Hospital Charge Code |
7504345001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$90.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,145.53
|
| Rate for Payer: Aetna Government |
$1,145.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$801.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$801.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$801.87
|
| Rate for Payer: Brighton Health Commercial |
$1,856.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,145.53
|
| 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 |
$1,145.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,145.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,030.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$973.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,019.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,145.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,019.52
|
| Rate for Payer: Group Health Inc Commercial |
$1,145.53
|
| Rate for Payer: Group Health Inc Medicare |
$1,145.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,145.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$973.70
|
| Rate for Payer: Healthfirst QHP |
$1,145.53
|
| Rate for Payer: Humana Medicare |
$1,168.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,145.53
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,145.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,145.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,088.25
|
| Rate for Payer: Wellcare Medicare |
$1,088.25
|
|
|
HC DILATE ESOPHAGUS,OVER GUIDE - ESOPHAGEAL DILATION
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 43453 TC
|
| Hospital Charge Code |
3614345301
|
|
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 DILATE ESOPHAGUS,OVER GUIDE - ESOPHAGEAL DILATION
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 43453 TC
|
| Hospital Charge Code |
3614345301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$864.15 |
| Max. Negotiated Rate |
$3,537.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,109.47
|
| Rate for Payer: Aetna Government |
$1,109.47
|
| Rate for Payer: Brighton Health Commercial |
$3,537.00
|
| 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 |
$2,358.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,358.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,650.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
|
|
HC DILATION/CATH OF SALIVARY DUCT
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 42660 TC
|
| Hospital Charge Code |
3614266001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC DILATION/CATH OF SALIVARY DUCT
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 42660 TC
|
| Hospital Charge Code |
3614266001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.99 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$153.07
|
| Rate for Payer: Aetna Government |
$153.07
|
| Rate for Payer: Brighton Health Commercial |
$1,002.75
|
| 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 |
$668.50
|
| Rate for Payer: Group Health Inc Commercial |
$668.50
|
| Rate for Payer: Group Health Inc Medicare |
$467.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.99
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DILATION/CURETTAGE,DIAGNOSTIC
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
3615812001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
|
HC DILATION/CURETTAGE,DIAGNOSTIC
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
3615812001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$271.77 |
| Max. Negotiated Rate |
$6,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$271.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC DILATION EXISTING NEPHROSTOMY, PERC (ADDON)
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
3615043601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC DILATION EXISTING NEPHROSTOMY, PERC (ADDON)
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
3615043601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.81 |
| Max. Negotiated Rate |
$4,298.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$4,023.75
|
| 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 |
$168.81
|
| 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 |
$1,468.00
|
| 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 DILATION NEW NEPHROSTOMY, PERC (ADDON)
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
3615043701
|
|
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 DILATION NEW NEPHROSTOMY, PERC (ADDON)
|
Facility
|
OP
|
$9,142.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
3615043701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.35 |
| Max. Negotiated Rate |
$6,856.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$280.35
|
| 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 DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
5105780001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$4,079.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| 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 |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.91
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,079.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
5105780001
|
|
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 DILATION OF SALIVARY DUCT
|
Facility
|
IP
|
$4,086.00
|
|
|
Service Code
|
CPT 42650
|
| Hospital Charge Code |
5104265001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.00
|
|
|
HC DILATION OF SALIVARY DUCT
|
Facility
|
OP
|
$4,086.00
|
|
|
Service Code
|
CPT 42650
|
| Hospital Charge Code |
5104265001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$1,900.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| 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 |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| 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 |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$69.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,900.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC DILATION URETHRAL STRUCT,MALE,INITIAL
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
3615360001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC DILATION URETHRAL STRUCT,MALE,INITIAL
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
3615360001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$297.16
|
| Rate for Payer: Aetna Government |
$297.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$208.01
|
| Rate for Payer: Brighton Health Commercial |
$533.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$297.16
|
| Rate for Payer: EmblemHealth Commercial |
$297.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.47
|
| Rate for Payer: Group Health Inc Commercial |
$297.16
|
| Rate for Payer: Group Health Inc Medicare |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.59
|
| Rate for Payer: Healthfirst QHP |
$297.16
|
| Rate for Payer: Humana Medicare |
$303.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.16
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$282.30
|
| Rate for Payer: Wellcare Medicare |
$282.30
|
|
|
HC DIPHTHERIA ANTIBODIES
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86648
|
| Hospital Charge Code |
3028664801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.21
|
| Rate for Payer: Aetna Government |
$15.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.65
|
| Rate for Payer: Brighton Health Commercial |
$28.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.21
|
| Rate for Payer: EmblemHealth Commercial |
$15.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.54
|
| Rate for Payer: Group Health Inc Commercial |
$15.21
|
| Rate for Payer: Group Health Inc Medicare |
$15.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.21
|
| Rate for Payer: Healthfirst QHP |
$15.21
|
| Rate for Payer: Humana Medicare |
$15.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.21
|
| Rate for Payer: United Healthcare Commercial |
$19.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.45
|
| Rate for Payer: Wellcare Medicare |
$13.69
|
|
|
HC DIPHTHERIA ANTIBODIES
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86648
|
| Hospital Charge Code |
3028664801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$19.00 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.00
|
|
|
HC DIRECT REFER HOSPITAL OBSERVATION
|
Facility
|
OP
|
$1,528.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
762G037901
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$2,500.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$835.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$749.10
|
| Rate for Payer: Aetna Government |
$749.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$524.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$524.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$524.37
|
| Rate for Payer: Brighton Health Commercial |
$1,927.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$749.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,104.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,788.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$749.10
|
| Rate for Payer: EmblemHealth Commercial |
$749.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$674.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$636.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$666.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$749.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$666.70
|
| Rate for Payer: Group Health Inc Commercial |
$749.10
|
| Rate for Payer: Group Health Inc Medicare |
$749.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,500.00
|
| Rate for Payer: Healthfirst QHP |
$749.10
|
| Rate for Payer: Humana Medicare |
$764.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.10
|
| Rate for Payer: United Healthcare Commercial |
$2,278.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$749.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$749.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$350.00
|
| Rate for Payer: Wellcare Medicare |
$711.64
|
|
