|
HC DOPPLER ECHO EXAM HEART - TEE COMPLETE W/ DOPPLER & COLOR
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
4839332007
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.50
|
|
|
HC DOPPLER ECHO EXAM HEART - TEE COMPLETE W/ DOPPLER, COLOR & CONTRAST
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
4839332008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.50
|
|
|
HC DOPPLER ECHO EXAM HEART - TEE COMPLETE W/ DOPPLER, COLOR & CONTRAST
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
4839332008
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$569.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$133.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.59
|
| Rate for Payer: Aetna Government |
$47.59
|
| Rate for Payer: Brighton Health Commercial |
$182.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$194.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$165.24
|
| Rate for Payer: EmblemHealth Commercial |
$121.50
|
| Rate for Payer: Group Health Inc Commercial |
$121.50
|
| Rate for Payer: Group Health Inc Medicare |
$85.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$121.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$121.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.02
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER ECHO EXAM HEART - TTE LIMITED W/ COLOR
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4839332103
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC DOPPLER ECHO EXAM HEART - TTE LIMITED W/ COLOR
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4839332103
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.16
|
| Rate for Payer: Aetna Government |
$24.16
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: EmblemHealth Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Medicare |
$510.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.30
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER ECHO EXAM HEART - TTE LIMITED W/ DOPPLER & COLOR
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4839332104
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.16
|
| Rate for Payer: Aetna Government |
$24.16
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: EmblemHealth Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Medicare |
$510.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.30
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER ECHO EXAM HEART - TTE LIMITED W/ DOPPLER & COLOR
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4839332104
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC DOPPLER ECHO EXAM HEART - TTE LIMITED W/ DOPPLER, COLOR & CONTRAST
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4839332105
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC DOPPLER ECHO EXAM HEART - TTE LIMITED W/ DOPPLER, COLOR & CONTRAST
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
4839332105
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$24.16 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.16
|
| Rate for Payer: Aetna Government |
$24.16
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: EmblemHealth Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Commercial |
$729.00
|
| Rate for Payer: Group Health Inc Medicare |
$510.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$729.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.30
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC DOPPLER FETAL MID CEREBRAL ARTERY
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76821 TC
|
| Hospital Charge Code |
4027682101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DOPPLER FETAL MID CEREBRAL ARTERY
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76821 TC
|
| Hospital Charge Code |
4027682101
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$45.05 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.05
|
| Rate for Payer: Aetna Government |
$45.05
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.12
|
| Rate for Payer: EmblemHealth Commercial |
$57.50
|
| 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 |
$57.50
|
| Rate for Payer: Healthfirst Essential Plan |
$175.12
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$77.83
|
|
|
HC DOPPLER FETAL UMBILICAL ARTERY - US UMBILICAL ARTERY DOPPLER
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
4027682001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC DOPPLER FETAL UMBILICAL ARTERY - US UMBILICAL ARTERY DOPPLER
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
4027682001
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.16
|
| Rate for Payer: Aetna Government |
$17.16
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.12
|
| Rate for Payer: EmblemHealth Commercial |
$21.87
|
| 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 |
$21.87
|
| Rate for Payer: Healthfirst Essential Plan |
$83.90
|
| Rate for Payer: United Healthcare Commercial |
$49.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$37.29
|
|
|
HC DRAIN ABSCESS OF EYELID
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
5106770001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.11 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$132.11
|
| 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 DRAIN ABSCESS OF EYELID
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
5106770001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC DRAIN ABSCESS PALATE, UVULA
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
4504200001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC DRAIN ABSCESS PALATE, UVULA
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
4504200001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$283.73
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$283.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC DRAINAGE ABSCESS/HEMATOMA, NASAL, INTERNAL
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
3613000001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$465.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| 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 |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$283.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| Rate for Payer: Group Health Inc Commercial |
$283.73
|
| Rate for Payer: Group Health Inc Medicare |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC DRAINAGE ABSCESS/HEMATOMA, NASAL, INTERNAL
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 30000
|
| Hospital Charge Code |
3613000001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.00
|
|
|
HC DRAINAGE ABSCESS/HEMATOMA, NASAL, SEPTUM
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
3613002001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$142.76 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$465.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$142.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC DRAINAGE ABSCESS/HEMATOMA, NASAL, SEPTUM
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 30020
|
| Hospital Charge Code |
3613002001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.00
|
|
|
HC DRAINAGE CATHETER EXCHANGE
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 49423 TC
|
| Hospital Charge Code |
3614942301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.42 |
| Max. Negotiated Rate |
$3,537.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$81.42
|
| Rate for Payer: Aetna Government |
$81.42
|
| 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 DRAINAGE CATHETER EXCHANGE
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 49423 TC
|
| Hospital Charge Code |
3614942301
|
|
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 DRAINAGE,EXT CANAL/ABCESS
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
5106902001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC DRAINAGE,EXT CANAL/ABCESS
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 69020
|
| Hospital Charge Code |
5106902001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.94 |
| Max. Negotiated Rate |
$902.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| 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 |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| 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 |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$165.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$167.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$902.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
