|
HC IMMUNOHISTO ANTB ADDL SLIDE - LAB IMHISTOCHEM/CYTCHM EA ADDL ANT SLD
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 88341 TC
|
| Hospital Charge Code |
3128834101
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$139.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$139.00
|
|
|
HC IMMUNOHISTOCHEMISTRY/IMMUNOCYTOCHEMISTRY, PER SPECIMEN; EACH ANTIBODY
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$448.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$439.51
|
| Rate for Payer: Aetna Government |
$439.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$307.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$307.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.66
|
| Rate for Payer: Brighton Health Commercial |
$439.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$439.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$439.51
|
| Rate for Payer: EmblemHealth Commercial |
$197.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$395.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$373.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$391.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$439.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$391.16
|
| Rate for Payer: Group Health Inc Commercial |
$439.51
|
| Rate for Payer: Group Health Inc Medicare |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$439.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$439.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.62
|
| Rate for Payer: Healthfirst Essential Plan |
$57.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$439.51
|
| Rate for Payer: Healthfirst QHP |
$439.51
|
| Rate for Payer: Humana Medicare |
$448.30
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$439.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$439.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.62
|
| Rate for Payer: Wellcare Medicare |
$395.56
|
|
|
HC IMMUNOHISTOCHEMISTRY/IMMUNOCYTOCHEMISTRY, PER SPECIMEN; EACH ANTIBODY
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
3108834401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC IMMUNOTHERAPY, 2+ INJECTIONS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
5109511701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| 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 |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.17
|
| 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 |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC IMMUNOTHERAPY, 2+ INJECTIONS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 95117
|
| Hospital Charge Code |
5109511701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC IMMUNOTHERAPY, MANY ANTIGENS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 95125
|
| Hospital Charge Code |
9409512501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC IMMUNOTHERAPY, MANY ANTIGENS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 95125
|
| Hospital Charge Code |
9409512501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.94
|
| Rate for Payer: Aetna Government |
$10.94
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.76
|
| Rate for Payer: EmblemHealth Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Medicare |
$19.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
|
|
HC IMMUNOTHERAPY, ONE INJECTION
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
5109511501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC IMMUNOTHERAPY, ONE INJECTION
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 95115
|
| Hospital Charge Code |
5109511501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.65 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| 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 |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.17
|
| 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 |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC IMMUNOTHER,SINGLE/MULT AGS
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
5109516501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| 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 |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$50.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.17
|
| 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 |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$59.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC IMMUNOTHER,SINGLE/MULT AGS
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 95165
|
| Hospital Charge Code |
5109516501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC IMPLANT NEUROELECTRODES
|
Facility
|
IP
|
$18,198.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
5106456101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9,099.00 |
| Max. Negotiated Rate |
$9,099.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9,099.00
|
|
|
HC IMPLANT NEUROELECTRODES
|
Facility
|
OP
|
$18,198.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
5106456101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$10,071.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,018.68
|
| Rate for Payer: Aetna Government |
$8,018.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10,071.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10,071.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,476.04
|
| Rate for Payer: Amida Care Medicaid |
$4,476.04
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,018.68
|
| 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 |
$8,018.68
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$10,071.14
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$4,476.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,476.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,071.14
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,071.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,018.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,699.81
|
| 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 |
$4,476.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5,217.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,476.04
|
| Rate for Payer: Healthfirst Essential Plan |
$10,071.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,815.88
|
| Rate for Payer: Healthfirst QHP |
$7,295.93
|
| Rate for Payer: Humana Medicare |
$8,179.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$8,419.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,018.68
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$4,476.04
|
| Rate for Payer: SOMOS Essential |
$10,071.14
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$10,071.14
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$4,923.59
|
| Rate for Payer: United Healthcare Medicaid |
$4,476.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,018.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,018.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,476.04
|
| Rate for Payer: Wellcare Medicare |
$7,617.75
|
|
|
HC IMPL SP/BR PUMP REFILLING & MAINT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
9409599101
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$633.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$538.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$360.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$378.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$396.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC IMPL SP/BR PUMP REFILLING & MAINT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 95991
|
| Hospital Charge Code |
9409599101
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC IMPRESSION & CUSTOM PREP, ORAL SURGICAL SPLINT
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
3612108501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC IMPRESSION & CUSTOM PREP, ORAL SURGICAL SPLINT
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 21085
|
| Hospital Charge Code |
3612108501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$462.00
|
| 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 |
$551.96
|
| 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 INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
3614270001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$462.00
|
| 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 |
$160.00
|
| 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 INC/DRAIN PERITONSIL ABSCESS
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
3614270001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC INCIS/DRAIN ARM/ELBOW INFECT BURSA
|
Facility
|
IP
|
$4,497.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
3612393101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,248.50 |
| Max. Negotiated Rate |
$2,248.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,248.50
|
|
|
HC INCIS/DRAIN ARM/ELBOW INFECT BURSA
|
Facility
|
OP
|
$4,497.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
3612393101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$3,372.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,372.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$191.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
3615470001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 54700
|
| Hospital Charge Code |
3615470001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$247.64 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,502.91
|
| Rate for Payer: Aetna Government |
$2,502.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,752.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,752.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,752.04
|
| Rate for Payer: Brighton Health Commercial |
$4,023.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,502.91
|
| 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 |
$2,502.91
|
| Rate for Payer: EmblemHealth Commercial |
$2,502.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,252.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,127.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,227.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,502.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,227.59
|
| Rate for Payer: Group Health Inc Commercial |
$2,502.91
|
| Rate for Payer: Group Health Inc Medicare |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$247.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,127.47
|
| Rate for Payer: Healthfirst QHP |
$2,502.91
|
| Rate for Payer: Humana Medicare |
$2,552.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,502.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,502.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,377.76
|
| Rate for Payer: Wellcare Medicare |
$2,377.76
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
IP
|
$2,617.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,308.50 |
| Max. Negotiated Rate |
$1,308.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,308.50
|
|
|
HC INCISE/DRAIN CONJUNCTIVA
|
Facility
|
OP
|
$2,617.00
|
|
|
Service Code
|
CPT 68020
|
| Hospital Charge Code |
3616802001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,183.38
|
| Rate for Payer: Aetna Government |
$1,183.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$828.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$828.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$828.37
|
| Rate for Payer: Brighton Health Commercial |
$1,962.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.38
|
| 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 |
$1,183.38
|
| Rate for Payer: EmblemHealth Commercial |
$1,183.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,053.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,053.21
|
| Rate for Payer: Group Health Inc Commercial |
$1,183.38
|
| Rate for Payer: Group Health Inc Medicare |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.87
|
| Rate for Payer: Healthfirst QHP |
$1,183.38
|
| Rate for Payer: Humana Medicare |
$1,207.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.38
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,183.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,124.21
|
| Rate for Payer: Wellcare Medicare |
$1,124.21
|
|
