|
HC ENDOVENOUS LASER, 1ST VEIN
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 36478 TC
|
| Hospital Charge Code |
3613647801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,222.78 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,222.78
|
| Rate for Payer: Aetna Government |
$1,222.78
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| 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 |
$4,196.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC ENDOVENOUS LASER VEIN ADDON
|
Facility
|
OP
|
$6,231.00
|
|
|
Service Code
|
CPT 36479 TC
|
| Hospital Charge Code |
3613647901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$313.95 |
| Max. Negotiated Rate |
$4,673.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$313.95
|
| Rate for Payer: Aetna Government |
$313.95
|
| Rate for Payer: Brighton Health Commercial |
$4,673.25
|
| 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 |
$3,115.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,115.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,180.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,115.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,115.50
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ENDOVENOUS LASER VEIN ADDON
|
Facility
|
IP
|
$6,231.00
|
|
|
Service Code
|
CPT 36479 TC
|
| Hospital Charge Code |
3613647901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,115.50 |
| Max. Negotiated Rate |
$3,115.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,115.50
|
|
|
HC ENDOVENOUS RF, VEIN ADD-ON
|
Facility
|
OP
|
$2,077.00
|
|
|
Service Code
|
CPT 36476 TC
|
| Hospital Charge Code |
3613647601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$303.30 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$303.30
|
| Rate for Payer: Aetna Government |
$303.30
|
| Rate for Payer: Brighton Health Commercial |
$1,557.75
|
| 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 |
$1,038.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,038.50
|
| Rate for Payer: Group Health Inc Medicare |
$726.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,038.50
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ENDOVENOUS RF, VEIN ADD-ON
|
Facility
|
IP
|
$2,077.00
|
|
|
Service Code
|
CPT 36476 TC
|
| Hospital Charge Code |
3613647601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,038.50 |
| Max. Negotiated Rate |
$1,038.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,038.50
|
|
|
HC ENTEROCLYSIS
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
3614400501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$989.00 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$989.00
|
|
|
HC ENTEROCLYSIS
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
3614400501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$692.30 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,087.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,298.66
|
| Rate for Payer: Aetna Government |
$1,298.66
|
| Rate for Payer: Brighton Health Commercial |
$1,483.50
|
| 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 |
$989.00
|
| Rate for Payer: Group Health Inc Commercial |
$989.00
|
| Rate for Payer: Group Health Inc Medicare |
$692.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$989.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$989.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,297.69
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIE
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIE
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$51.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIE IGG/IGM
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ENTEROVIRUS ANTIBODY - COXSACKIE IGG/IGM
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665804
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
HC ENTEROVIRUS ANTIBODY - ECHOVIRUS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ENTEROVIRUS ANTIBODY - ECHOVIRUS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665805
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
HC ENTEROVIRUS ANTIBODY - POLIO VIRUS
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC ENTEROVIRUS ANTIBODY - POLIO VIRUS
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$24.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
HC ENTEROVIRUS ANTIBODY - POLIOVIRUS ANTIBODIES, TYPES 1, 2, AND 3
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665802
|
|
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 |
$13.03
|
| Rate for Payer: Aetna Government |
$13.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.12
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.03
|
| Rate for Payer: EmblemHealth Commercial |
$13.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.60
|
| Rate for Payer: Group Health Inc Commercial |
$13.03
|
| Rate for Payer: Group Health Inc Medicare |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.03
|
| Rate for Payer: Healthfirst QHP |
$13.03
|
| Rate for Payer: Humana Medicare |
$13.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare Commercial |
$16.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$11.73
|
|
|
HC ENTEROVIRUS ANTIBODY - POLIOVIRUS ANTIBODIES, TYPES 1, 2, AND 3
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3028665802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3068749801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC, ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87498
|
| Hospital Charge Code |
3068749801
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC ENVIROMENTAL INTERVENTION FOR MEDICAL MGMT
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 90882
|
| Hospital Charge Code |
9009088201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
|
|
HC ENVIROMENTAL INTERVENTION FOR MEDICAL MGMT
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 90882
|
| Hospital Charge Code |
9009088201
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.44
|
| Rate for Payer: Aetna Government |
$70.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22.33
|
| Rate for Payer: Amida Care Medicaid |
$22.33
|
| Rate for Payer: Brighton Health Commercial |
$150.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: EmblemHealth Commercial |
$100.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23.45
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.33
|
| Rate for Payer: Healthfirst Essential Plan |
$50.25
|
| Rate for Payer: Healthfirst QHP |
$36.40
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22.33
|
| Rate for Payer: SOMOS Essential |
$50.25
|
| Rate for Payer: United Healthcare Commercial |
$100.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$24.57
|
| Rate for Payer: United Healthcare Medicaid |
$22.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.33
|
|
|
HC ENZYME HISTOCHEMISTRY - BUNDLED CHARGE
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
3128831902
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$1,018.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$998.10
|
| Rate for Payer: Aetna Government |
$998.10
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$698.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$698.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$698.67
|
| Rate for Payer: Brighton Health Commercial |
$998.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$998.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$121.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$998.10
|
| Rate for Payer: EmblemHealth Commercial |
$155.97
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$898.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$848.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$888.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$998.10
|
| Rate for Payer: Fidelis Qualified Health Plan |
$888.31
|
| Rate for Payer: Group Health Inc Commercial |
$998.10
|
| Rate for Payer: Group Health Inc Medicare |
$998.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$998.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$998.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.54
|
| Rate for Payer: Healthfirst Essential Plan |
$79.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$998.10
|
| Rate for Payer: Healthfirst QHP |
$998.10
|
| Rate for Payer: Humana Medicare |
$1,018.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$998.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$998.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$998.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$35.54
|
| Rate for Payer: Wellcare Medicare |
$898.29
|
|
|
HC ENZYME HISTOCHEMISTRY - BUNDLED CHARGE
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
3128831902
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
|
|
HC EP ABLATE AV NODE FUNCTION
|
Facility
|
OP
|
$17,826.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
4809365001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$316.00 |
| Max. Negotiated Rate |
$14,260.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,804.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9,271.29
|
| Rate for Payer: Aetna Government |
$9,271.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,489.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,489.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,489.90
|
| Rate for Payer: Brighton Health Commercial |
$13,369.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9,271.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14,260.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,121.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$9,271.29
|
| Rate for Payer: EmblemHealth Commercial |
$9,271.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8,344.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,880.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,251.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$9,271.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,251.45
|
| Rate for Payer: Group Health Inc Commercial |
$9,271.29
|
| Rate for Payer: Group Health Inc Medicare |
$9,271.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,271.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9,271.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$670.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,880.60
|
| Rate for Payer: Healthfirst QHP |
$9,271.29
|
| Rate for Payer: Humana Medicare |
$9,456.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9,271.29
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,271.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9,271.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8,807.73
|
| Rate for Payer: Wellcare Medicare |
$8,807.73
|
|
|
HC EP ABLATE AV NODE FUNCTION
|
Facility
|
IP
|
$17,826.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
4809365001
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$8,913.00 |
| Max. Negotiated Rate |
$8,913.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,913.00
|
|
