|
HC EMERGENCY DEPARTMENT LEVEL 1 VISIT LIMITED/MINOR PROB
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
4509928101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.58
|
| Rate for Payer: Aetna Government |
$107.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$75.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$75.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$75.31
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$120.00
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$107.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.58
|
| 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 |
$107.58
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.75
|
| 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 |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$107.58
|
| Rate for Payer: Humana Medicare |
$109.73
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$112.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.58
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$102.20
|
| Rate for Payer: Wellcare Medicare |
$102.20
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$489.50 |
| Max. Negotiated Rate |
$489.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$489.50
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 2 VISIT LOW/MODER SEVERITY
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
4509928201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$193.49
|
| Rate for Payer: Aetna Government |
$193.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$135.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$135.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$135.44
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$120.00
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$193.49
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$193.49
|
| 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 |
$193.49
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$174.14
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$164.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$172.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$193.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$172.21
|
| 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 |
$193.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$193.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$193.49
|
| Rate for Payer: Humana Medicare |
$197.36
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$203.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$193.49
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$193.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.82
|
| Rate for Payer: Wellcare Medicare |
$183.82
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Facility
|
IP
|
$1,246.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$623.00 |
| Max. Negotiated Rate |
$623.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$623.00
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 3 VISIT MODERATE SEVERITY
|
Facility
|
OP
|
$1,246.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
4509928301
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$338.31
|
| Rate for Payer: Aetna Government |
$338.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$236.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$236.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$236.82
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$120.00
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$338.31
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$338.31
|
| 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 |
$338.31
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$304.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$287.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$301.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$338.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.10
|
| 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 |
$338.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$338.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$338.31
|
| Rate for Payer: Humana Medicare |
$345.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$355.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$338.31
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$338.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$338.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$321.39
|
| Rate for Payer: Wellcare Medicare |
$321.39
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Facility
|
OP
|
$1,885.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$520.28
|
| Rate for Payer: Aetna Government |
$520.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$364.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$364.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$364.20
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$120.00
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$520.28
|
| 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 |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$520.28
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$468.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$442.24
|
| Rate for Payer: Fidelis Essential Plan QHP |
$463.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$520.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$463.05
|
| 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 |
$520.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$520.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$520.28
|
| Rate for Payer: Humana Medicare |
$530.69
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$546.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$520.28
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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 |
$494.27
|
| Rate for Payer: Wellcare Medicare |
$494.27
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 4 VISIT HIGH/URGENT SEVERITY
|
Facility
|
IP
|
$1,885.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
4509928401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$942.50 |
| Max. Negotiated Rate |
$942.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$942.50
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
OP
|
$3,480.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$120.00
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$749.10
|
| 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 |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$749.10
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$749.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$749.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$749.10
|
| Rate for Payer: Humana Medicare |
$764.08
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$786.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$749.10
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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 |
$711.64
|
| Rate for Payer: Wellcare Medicare |
$711.64
|
|
|
HC EMERGENCY DEPARTMENT LEVEL 5 VISIT HIGH SEVERITY&THREAT FUNC
|
Facility
|
IP
|
$3,480.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
4509928501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,740.00 |
| Max. Negotiated Rate |
$1,740.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,740.00
|
|
|
HC EMG ANAL/URETHR SPHINCT OTHER THAN NEEDLE
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 51784 TC
|
| Hospital Charge Code |
5105178401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.52 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$141.36
|
| Rate for Payer: Aetna Government |
$141.36
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$203.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.45
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC EMG ANAL/URETHR SPHINCT OTHER THAN NEEDLE
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 51784 TC
|
| Hospital Charge Code |
5105178401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
|
|
HC EMG, NEEDLE, ONE LIMB - EMG 1 LIMB
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
9229586001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC EMG, NEEDLE, ONE LIMB - EMG 1 LIMB
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 95860
|
| Hospital Charge Code |
9229586001
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$264.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$224.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12 - EMG THORACIC/PARASPINAL
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 95869 TC
|
| Hospital Charge Code |
9229586901
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.63
|
| Rate for Payer: Aetna Government |
$65.63
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: EmblemHealth Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Medicare |
$146.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.30
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
|
|
HC EMG,NEEDLE,THOR PARASPIN MUS,EXC T1/T12 - EMG THORACIC/PARASPINAL
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 95869 TC
|
| Hospital Charge Code |
9229586901
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC ENCEPHALITIS CALIFORN ANTBDY - ENCEPHALITIS, CALIFORNIA ANTIBODY IGG
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
3028665101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.19
|
| Rate for Payer: Aetna Government |
$13.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.23
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.19
|
| Rate for Payer: EmblemHealth Commercial |
$13.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.74
|
| Rate for Payer: Group Health Inc Commercial |
$13.19
|
| Rate for Payer: Group Health Inc Medicare |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.19
|
| Rate for Payer: Healthfirst QHP |
$13.19
|
| Rate for Payer: Humana Medicare |
$13.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.87
|
|
|
HC ENCEPHALITIS CALIFORN ANTBDY - ENCEPHALITIS, CALIFORNIA ANTIBODY IGG
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
3028665101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ENCEPHALTIS EAST EQNE ANBDY - ENCEPHALITIS, EASTERN EQUINE ANTI IGG
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
3028665201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ENCEPHALTIS EAST EQNE ANBDY - ENCEPHALITIS, EASTERN EQUINE ANTI IGG
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
3028665201
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.19
|
| Rate for Payer: Aetna Government |
$13.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.23
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.19
|
| Rate for Payer: EmblemHealth Commercial |
$13.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.74
|
| Rate for Payer: Group Health Inc Commercial |
$13.19
|
| Rate for Payer: Group Health Inc Medicare |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.19
|
| Rate for Payer: Healthfirst QHP |
$13.19
|
| Rate for Payer: Humana Medicare |
$13.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.87
|
|
|
HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGG
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
3028665301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.19
|
| Rate for Payer: Aetna Government |
$13.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.23
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.19
|
| Rate for Payer: EmblemHealth Commercial |
$13.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.74
|
| Rate for Payer: Group Health Inc Commercial |
$13.19
|
| Rate for Payer: Group Health Inc Medicare |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.19
|
| Rate for Payer: Healthfirst QHP |
$13.19
|
| Rate for Payer: Humana Medicare |
$13.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.87
|
|
|
HC ENCEPHALTIS ST LOUIS ANTBODY - ENCEPHALITIS, ST. LOUIS ANTIBODY, IGG
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86653
|
| Hospital Charge Code |
3028665301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ENCEPHALTIS WEST EQNE ANTBDY - ENCEPHALITIS, WESTERN EQUINE ANTI IGG
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
3028665401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.19
|
| Rate for Payer: Aetna Government |
$13.19
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.23
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.86
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.19
|
| Rate for Payer: EmblemHealth Commercial |
$13.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.74
|
| Rate for Payer: Group Health Inc Commercial |
$13.19
|
| Rate for Payer: Group Health Inc Medicare |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.19
|
| Rate for Payer: Healthfirst QHP |
$13.19
|
| Rate for Payer: Humana Medicare |
$13.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$16.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.87
|
|
|
HC ENCEPHALTIS WEST EQNE ANTBDY - ENCEPHALITIS, WESTERN EQUINE ANTI IGG
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
3028665401
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$1,933.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
3615750501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.51 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$1,449.75
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,063.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,063.89
|
| 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 |
$1,063.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,063.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$127.50
|
| 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: Senior Whole Health Medicare Advantage |
$1,063.89
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| 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 ENDOCERVICAL CURETTAGE
|
Facility
|
IP
|
$1,933.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
3615750501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$966.50 |
| Max. Negotiated Rate |
$966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.50
|
|
