|
HC INJECTION,SACROILIAC JOINT
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
3612709601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.42 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$161.42
|
| Rate for Payer: Aetna Government |
$161.42
|
| Rate for Payer: Brighton Health Commercial |
$770.25
|
| 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 |
$513.50
|
| Rate for Payer: Group Health Inc Commercial |
$513.50
|
| Rate for Payer: Group Health Inc Medicare |
$359.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$513.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$513.50
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9409637201
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
9409637201
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$94.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| Rate for Payer: Brighton Health Commercial |
$129.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$137.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$116.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$30.06
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$13.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,336.00
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$21.78
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$91.31
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$30.06
|
| Rate for Payer: United Healthcare Commercial |
$86.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.36
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9409637501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, NEW DRUG
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
9409637501
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$78.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53.90
|
| 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 |
$73.50
|
| 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 |
$78.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| 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 |
$56.37
|
| Rate for Payer: Group Health Inc Medicare |
$56.37
|
| 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 |
$16.87
|
| 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 |
$49.00
|
| 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 INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
2609637601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$40.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.94
|
| Rate for Payer: Aetna Government |
$12.94
|
| Rate for Payer: Brighton Health Commercial |
$55.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.32
|
| Rate for Payer: EmblemHealth Commercial |
$37.00
|
| Rate for Payer: Group Health Inc Commercial |
$37.00
|
| Rate for Payer: Group Health Inc Medicare |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.00
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, EA ADD, SAME DRUG
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
2609637601
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.00 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.00
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
2609637402
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$444.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.43
|
| Rate for Payer: Aetna Government |
$257.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.20
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$444.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.43
|
| Rate for Payer: EmblemHealth Commercial |
$257.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.11
|
| Rate for Payer: Group Health Inc Commercial |
$257.43
|
| Rate for Payer: Group Health Inc Medicare |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.82
|
| Rate for Payer: Healthfirst QHP |
$257.43
|
| Rate for Payer: Humana Medicare |
$262.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.43
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$244.56
|
| Rate for Payer: Wellcare Medicare |
$244.56
|
|
|
HC INJECTION,THERAP/PROPH/DIAGNOST, IV PUSH, INITIAL DRUG
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
2609637402
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC INJECT NERV BLCK,AXILLARY NERV
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
3616441701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.18 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$1,844.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| 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 |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$1,087.77
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$1,087.77
|
| Rate for Payer: Group Health Inc Medicare |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC INJECT NERV BLCK,AXILLARY NERV
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
3616441701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJECT NERV BLCK,CELIAC PLEXUS
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64530 TC
|
| Hospital Charge Code |
3616453001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.83 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$218.83
|
| Rate for Payer: Aetna Government |
$218.83
|
| Rate for Payer: Brighton Health Commercial |
$1,844.25
|
| 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 |
$1,229.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,229.50
|
| Rate for Payer: Group Health Inc Medicare |
$860.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC INJECT NERV BLCK,CELIAC PLEXUS
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64530 TC
|
| Hospital Charge Code |
3616453001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJECT NERV BLCK,CERV PLEXUS
|
Facility
|
OP
|
$2,633.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
3616441301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$921.55 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,448.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,316.50
|
| Rate for Payer: Aetna Government |
$1,316.50
|
| Rate for Payer: Brighton Health Commercial |
$1,974.75
|
| 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 |
$1,316.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,316.50
|
| Rate for Payer: Group Health Inc Medicare |
$921.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,316.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,316.50
|
|
|
HC INJECT NERV BLCK,CERV PLEXUS
|
Facility
|
IP
|
$2,633.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
3616441301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,316.50 |
| Max. Negotiated Rate |
$1,316.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,316.50
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
3616440501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$611.25
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$35.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.67
|
| 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: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
3616440501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.50 |
| Max. Negotiated Rate |
$407.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.50
|
|
|
HC INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
7616440501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$35.90 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.67
|
| 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: Senior Whole Health Medicare Advantage |
$360.67
|
| 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 INJECT NERV BLCK,GREAT OCCIPTL
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
7616440501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJECT NERV BLCK,ILIOINGU/ILIOHYP
|
Facility
|
OP
|
$1,932.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
3616442501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$1,449.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| 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 |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$846.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| Rate for Payer: Group Health Inc Commercial |
$846.13
|
| Rate for Payer: Group Health Inc Medicare |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC INJECT NERV BLCK,ILIOINGU/ILIOHYP
|
Facility
|
IP
|
$1,932.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
3616442501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$966.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$966.00
|
|
|
HC INJECT NERV BLCK,INTERCOSTAL,ONE
|
Facility
|
OP
|
$1,898.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
3616442001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.36 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$1,423.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| 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 |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$846.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| Rate for Payer: Group Health Inc Commercial |
$846.13
|
| Rate for Payer: Group Health Inc Medicare |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$371.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC INJECT NERV BLCK,INTERCOSTAL,ONE
|
Facility
|
IP
|
$1,898.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
3616442001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$949.00 |
| Max. Negotiated Rate |
$949.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$949.00
|
|
|
HC INJECT NERV BLCK,INTERCOST,MULTPL
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64421 TC
|
| Hospital Charge Code |
3616442101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJECT NERV BLCK,INTERCOST,MULTPL
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64421 TC
|
| Hospital Charge Code |
3616442101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$171.91 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$171.91
|
| Rate for Payer: Aetna Government |
$171.91
|
| Rate for Payer: Brighton Health Commercial |
$1,844.25
|
| 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 |
$1,229.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,229.50
|
| Rate for Payer: Group Health Inc Medicare |
$860.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
