|
HC EGD INTRMURAL NEEDLE ASPIR/BIOP ALTERED ANATOMY - EGD
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
7504324201
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$292.82 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,317.78
|
| Rate for Payer: Aetna Government |
$2,317.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,622.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,622.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,622.45
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,317.78
|
| 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 |
$2,317.78
|
| Rate for Payer: EmblemHealth Commercial |
$2,317.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,086.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,970.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,062.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,317.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,062.82
|
| Rate for Payer: Group Health Inc Commercial |
$2,317.78
|
| Rate for Payer: Group Health Inc Medicare |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$292.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,970.11
|
| Rate for Payer: Healthfirst QHP |
$2,317.78
|
| Rate for Payer: Humana Medicare |
$2,364.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,317.78
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,317.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,317.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,201.89
|
| Rate for Payer: Wellcare Medicare |
$2,201.89
|
|
|
HC EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS - EGD
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
7504323801
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$260.39 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,317.78
|
| Rate for Payer: Aetna Government |
$2,317.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,622.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,622.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,622.45
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,317.78
|
| 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 |
$2,317.78
|
| Rate for Payer: EmblemHealth Commercial |
$2,317.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,086.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,970.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,062.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,317.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,062.82
|
| Rate for Payer: Group Health Inc Commercial |
$2,317.78
|
| Rate for Payer: Group Health Inc Medicare |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$260.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,970.11
|
| Rate for Payer: Healthfirst QHP |
$2,317.78
|
| Rate for Payer: Humana Medicare |
$2,364.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,317.78
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,317.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,317.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,201.89
|
| Rate for Payer: Wellcare Medicare |
$2,201.89
|
|
|
HC EGD INTRMURAL US NEEDLE ASPIRATE/BIOPSY ESOPHAGS - EGD
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 43238
|
| Hospital Charge Code |
7504323801
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,358.00 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
|
|
HC EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE - EGD
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
7504324601
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$227.67 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,317.78
|
| Rate for Payer: Aetna Government |
$2,317.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,622.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,622.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,622.45
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,317.78
|
| 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 |
$2,317.78
|
| Rate for Payer: EmblemHealth Commercial |
$2,317.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,086.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,970.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,062.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,317.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,062.82
|
| Rate for Payer: Group Health Inc Commercial |
$2,317.78
|
| Rate for Payer: Group Health Inc Medicare |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$227.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,970.11
|
| Rate for Payer: Healthfirst QHP |
$2,317.78
|
| Rate for Payer: Humana Medicare |
$2,364.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,317.78
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,317.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,317.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,201.89
|
| Rate for Payer: Wellcare Medicare |
$2,201.89
|
|
|
HC EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE - EGD
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
7504324601
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,358.00 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
|
|
HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD
|
Facility
|
IP
|
$2,889.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
7504323901
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,444.50 |
| Max. Negotiated Rate |
$1,444.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,444.50
|
|
|
HC EGD TRANSORAL BIOPSY SINGLE/MULTIPLE - EGD
|
Facility
|
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
7504323901
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$155.38 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$955.00
|
| 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 |
$155.38
|
| 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 EGD US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM - ENDO US (UPPER)
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
7504325902
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,358.00 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
|
|
HC EGD US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM - ENDO US (UPPER)
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 43259
|
| Hospital Charge Code |
7504325902
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$253.08 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,317.78
|
| Rate for Payer: Aetna Government |
$2,317.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,622.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,622.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,622.45
|
| Rate for Payer: Brighton Health Commercial |
$955.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,317.78
|
| 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 |
$2,317.78
|
| Rate for Payer: EmblemHealth Commercial |
$2,317.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,086.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,970.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,062.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,317.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,062.82
|
| Rate for Payer: Group Health Inc Commercial |
$2,317.78
|
| Rate for Payer: Group Health Inc Medicare |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,317.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,970.11
|
| Rate for Payer: Healthfirst QHP |
$2,317.78
|
| Rate for Payer: Humana Medicare |
$2,364.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,317.78
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,317.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,317.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,201.89
|
| Rate for Payer: Wellcare Medicare |
$2,201.89
|
|
|
HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
3028666601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.18
|
| Rate for Payer: Aetna Government |
$10.18
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.13
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.13
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.13
|
| Rate for Payer: Brighton Health Commercial |
$18.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.55
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.18
|
| Rate for Payer: EmblemHealth Commercial |
$10.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.06
|
| Rate for Payer: Group Health Inc Commercial |
$10.18
|
| Rate for Payer: Group Health Inc Medicare |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.18
|
| Rate for Payer: Healthfirst QHP |
$10.18
|
| Rate for Payer: Humana Medicare |
$10.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare Commercial |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$9.16
|
|
|
HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
3028666601
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$12.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.50
|
|
|
HC EKG ROUTINE, 12 LEAD, INT & REPORT ONLY
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
7309301001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.50
|
|
|
HC EKG ROUTINE, 12 LEAD, INT & REPORT ONLY
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
7309301001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$133.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.25
|
| Rate for Payer: Aetna Government |
$7.25
|
| Rate for Payer: Brighton Health Commercial |
$125.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$133.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$113.56
|
| Rate for Payer: EmblemHealth Commercial |
$83.50
|
| Rate for Payer: Group Health Inc Commercial |
$83.50
|
| Rate for Payer: Group Health Inc Medicare |
$58.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.80
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
|
|
HC EKG ROUTINE, 12 LEAD, W/REPORT
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 93000 TC
|
| Hospital Charge Code |
7309300001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
|
|
HC EKG ROUTINE, 12 LEAD, W/REPORT
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 93000 TC
|
| Hospital Charge Code |
7309300001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.04
|
| Rate for Payer: Aetna Government |
$15.04
|
| Rate for Payer: Brighton Health Commercial |
$108.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.60
|
| Rate for Payer: EmblemHealth Commercial |
$72.50
|
| Rate for Payer: Group Health Inc Commercial |
$72.50
|
| Rate for Payer: Group Health Inc Medicare |
$50.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.50
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
|
|
HC ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH W/PRGRMG
|
Facility
|
IP
|
$343.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
9209597201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$171.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.50
|
|
|
HC ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH W/PRGRMG
|
Facility
|
OP
|
$343.00
|
|
|
Service Code
|
CPT 95972
|
| Hospital Charge Code |
9209597201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$43.92 |
| Max. Negotiated Rate |
$274.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.15
|
| Rate for Payer: Aetna Government |
$112.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$78.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$78.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$78.50
|
| Rate for Payer: Brighton Health Commercial |
$257.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$112.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$274.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$233.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$112.15
|
| Rate for Payer: EmblemHealth Commercial |
$112.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$100.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$95.33
|
| Rate for Payer: Fidelis Essential Plan QHP |
$99.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$112.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$99.81
|
| Rate for Payer: Group Health Inc Commercial |
$112.15
|
| Rate for Payer: Group Health Inc Medicare |
$112.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$95.33
|
| Rate for Payer: Healthfirst QHP |
$112.15
|
| Rate for Payer: Humana Medicare |
$114.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$112.15
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$112.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.54
|
| Rate for Payer: Wellcare Medicare |
$106.54
|
|
|
HC ELEC ANALYSIS INFUSION PUMP W/O REPROGRAM OR REFILL
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 62367
|
| Hospital Charge Code |
5106236701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.91 |
| Max. Negotiated Rate |
$384.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$366.44
|
| Rate for Payer: Aetna Government |
$366.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$256.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$256.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$256.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$366.44
|
| 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 |
$366.44
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$366.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.13
|
| 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 |
$366.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$311.47
|
| Rate for Payer: Healthfirst QHP |
$366.44
|
| Rate for Payer: Humana Medicare |
$373.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$366.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$348.12
|
| Rate for Payer: Wellcare Medicare |
$348.12
|
|
|
HC ELEC ANALYSIS INFUSION PUMP W/O REPROGRAM OR REFILL
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 62367
|
| Hospital Charge Code |
5106236701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.00
|
|
|
HC ELEC ANALYSIS INFUSION PUMP W/REPROGRAM
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 62368
|
| Hospital Charge Code |
5106236801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$384.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$366.44
|
| Rate for Payer: Aetna Government |
$366.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$256.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$256.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$256.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$366.44
|
| 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 |
$366.44
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$366.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.13
|
| 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 |
$366.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$311.47
|
| Rate for Payer: Healthfirst QHP |
$366.44
|
| Rate for Payer: Humana Medicare |
$373.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$366.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$348.12
|
| Rate for Payer: Wellcare Medicare |
$348.12
|
|
|
HC ELEC ANALYSIS INFUSION PUMP W/REPROGRAM
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 62368
|
| Hospital Charge Code |
5106236801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.00
|
|
|
HC ELEC ANALYSIS INFUSION PUMP W/REPROGRAM & REFILL
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 62369
|
| Hospital Charge Code |
5106236901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$410.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$410.00
|
|
|
HC ELEC ANALYSIS INFUSION PUMP W/REPROGRAM & REFILL
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 62369
|
| Hospital Charge Code |
5106236901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.66 |
| Max. Negotiated Rate |
$384.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$366.44
|
| Rate for Payer: Aetna Government |
$366.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$256.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$256.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$256.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$366.44
|
| 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 |
$366.44
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$329.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$311.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$326.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$366.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$326.13
|
| 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 |
$366.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$311.47
|
| Rate for Payer: Healthfirst QHP |
$366.44
|
| Rate for Payer: Humana Medicare |
$373.77
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$384.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$366.44
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$366.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$366.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$348.12
|
| Rate for Payer: Wellcare Medicare |
$348.12
|
|
|
HC ELECTROCARDIOGRAM, TRACING
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC ELECTROCARDIOGRAM, TRACING
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
7309300501
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
