|
HC INJX AA&/STRD TFRM EPIDURAL CERVICAL/THORACIC - FIRST LEVEL
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
3616447901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.99 |
| 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 |
$146.99
|
| 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 INJX AA&/STRD TFRM EPIDURAL - LUMBAR/SACRAL EACH ADDL
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
3616448401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.08 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.08
|
| Rate for Payer: Aetna Government |
$59.08
|
| Rate for Payer: Brighton Health Commercial |
$921.75
|
| 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 |
$614.50
|
| Rate for Payer: Group Health Inc Commercial |
$614.50
|
| Rate for Payer: Group Health Inc Medicare |
$430.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$614.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$56.08
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INJX AA&/STRD TFRM EPIDURAL - LUMBAR/SACRAL EACH ADDL
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
3616448401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.50 |
| Max. Negotiated Rate |
$614.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.50
|
|
|
HC INJX AA&/STRD TFRM EPIDURAL LUMBAR/SACRAL - FIRST LEVEL
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
3616448301
|
|
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 INJX AA&/STRD TFRM EPIDURAL LUMBAR/SACRAL - FIRST LEVEL
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
3616448301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.64 |
| 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 |
$124.64
|
| 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 INJX AA&/STRD - TIGEMINAL NERVE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5106440001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.50 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| 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 |
$77.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.50
|
| 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 |
$222.00
|
| 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 INJX AA&/STRD - TIGEMINAL NERVE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5106440001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJX AA&/STRD - VAGUS NERVE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
5106440801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| 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 |
$50.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.27
|
| 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 |
$222.00
|
| 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 INJX AA&/STRD - VAGUS NERVE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 64408
|
| Hospital Charge Code |
5106440801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJX EPIDURAL, BLOOD OR CLOT PATCH
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
3616227301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.03 |
| 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 |
$1,419.75
|
| 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 |
$127.03
|
| 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 INJX EPIDURAL, BLOOD OR CLOT PATCH
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
3616227301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$946.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.50
|
|
|
HC INJX EPIDURAL, CERVICAL/THORACIC
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 62281
|
| Hospital Charge Code |
3616228101
|
|
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 INJX EPIDURAL, CERVICAL/THORACIC
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 62281
|
| Hospital Charge Code |
3616228101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.57 |
| 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 |
$176.57
|
| 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 INJX EPIDURAL, LUMBAR, SACRAL (CAUDAL)
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
3616228201
|
|
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 INJX EPIDURAL, LUMBAR, SACRAL (CAUDAL)
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 62282
|
| Hospital Charge Code |
3616228201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.01 |
| 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 |
$160.01
|
| 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 INJX FOR CONTRAST KNEE ARTHROGRAPHY
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
CPT 27369 TC
|
| Hospital Charge Code |
3612736901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$232.00 |
| Max. Negotiated Rate |
$232.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.00
|
|
|
HC INJX FOR CONTRAST KNEE ARTHROGRAPHY
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
CPT 27369 TC
|
| Hospital Charge Code |
3612736901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.96 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$145.96
|
| Rate for Payer: Aetna Government |
$145.96
|
| Rate for Payer: Brighton Health Commercial |
$348.00
|
| 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 |
$232.00
|
| Rate for Payer: Group Health Inc Commercial |
$232.00
|
| Rate for Payer: Group Health Inc Medicare |
$162.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$232.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$232.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INJX FOR VISUALIZATION ILEAL CONDUIT
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
3615069001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$150.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.50
|
|
|
HC INJX FOR VISUALIZATION ILEAL CONDUIT
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
3615069001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$85.72
|
| Rate for Payer: Aetna Government |
$85.72
|
| Rate for Payer: Brighton Health Commercial |
$225.75
|
| 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 |
$150.50
|
| Rate for Payer: Group Health Inc Commercial |
$150.50
|
| Rate for Payer: Group Health Inc Medicare |
$105.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$150.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.83
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/GUIDANCE
|
Facility
|
IP
|
$2,533.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
3616232501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,266.50 |
| Max. Negotiated Rate |
$1,266.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,266.50
|
|
|
HC INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/GUIDANCE
|
Facility
|
OP
|
$2,533.00
|
|
|
Service Code
|
CPT 62325
|
| Hospital Charge Code |
3616232501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.68 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$1,899.75
|
| 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 |
$120.68
|
| 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 INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/OGUIDANCE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
5106232401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL CERVICAL/THORACIC W/OGUIDANCE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 62324
|
| Hospital Charge Code |
5106232401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$99.06 |
| Max. Negotiated Rate |
$1,412.00 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$99.06
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/GUIDANCE
|
Facility
|
IP
|
$2,533.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
3616232701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,266.50 |
| Max. Negotiated Rate |
$1,266.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,266.50
|
|
|
HC INJX INCL CATH PLACEMENT, INTERLAMINAR EPIDURAL LUMBAR/SACRAL W/GUIDANCE
|
Facility
|
OP
|
$2,533.00
|
|
|
Service Code
|
CPT 62327
|
| Hospital Charge Code |
3616232701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$1,899.75
|
| 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 |
$120.13
|
| 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
|
|
