|
HC INTERROG DEVICE EVAL HEART - CARDIAC DEVICE CHECK - IN CLINIC
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
4809328901
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.56
|
| Rate for Payer: Aetna Government |
$45.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.89
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$45.56
|
| Rate for Payer: EmblemHealth Commercial |
$45.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.55
|
| Rate for Payer: Group Health Inc Commercial |
$45.56
|
| Rate for Payer: Group Health Inc Medicare |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.73
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: Humana Medicare |
$46.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.28
|
| Rate for Payer: Wellcare Medicare |
$43.28
|
|
|
HC INTRAABDOMINAL VOIDING PRESSURE TEST
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 51797 TC
|
| Hospital Charge Code |
5105179701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$148.50 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.50
|
|
|
HC INTRAABDOMINAL VOIDING PRESSURE TEST
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 51797 TC
|
| Hospital Charge Code |
5105179701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.42 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.42
|
| Rate for Payer: Aetna Government |
$87.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$148.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC INTRACRANIAL ANGIOPLASTY
|
Facility
|
IP
|
$9,062.00
|
|
|
Service Code
|
CPT 61630 TC
|
| Hospital Charge Code |
3616163001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,531.00 |
| Max. Negotiated Rate |
$4,531.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,531.00
|
|
|
HC INTRACRANIAL ANGIOPLASTY
|
Facility
|
OP
|
$9,062.00
|
|
|
Service Code
|
CPT 61630 TC
|
| Hospital Charge Code |
3616163001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$6,796.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,984.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,617.28
|
| Rate for Payer: Aetna Government |
$1,617.28
|
| Rate for Payer: Brighton Health Commercial |
$6,796.50
|
| 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 |
$4,531.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,531.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,171.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,531.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,531.00
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC INTRACRANIAL COMPLETE STUDY - US HEAD DOPPLER COMPLETE
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
4029388601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$206.74 |
| Max. Negotiated Rate |
$564.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$387.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$295.34
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$564.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$479.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$266.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$265.81
|
| Rate for Payer: Group Health Inc Medicare |
$265.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$295.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC INTRACRANIAL COMPLETE STUDY - US HEAD DOPPLER COMPLETE
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT 93886
|
| Hospital Charge Code |
4029388601
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.50 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$352.50
|
|
|
HC INTRACRANIAL LIMITED STUDY - US HEAD DOPPLER LIMITED
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
4029388801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$271.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$129.93
|
| Rate for Payer: Aetna Government |
$129.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$90.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$90.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$90.95
|
| Rate for Payer: Brighton Health Commercial |
$129.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$129.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$271.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$230.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$129.93
|
| Rate for Payer: EmblemHealth Commercial |
$167.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$110.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$110.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$115.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$129.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$115.64
|
| Rate for Payer: Group Health Inc Commercial |
$116.94
|
| Rate for Payer: Group Health Inc Medicare |
$116.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$110.44
|
| Rate for Payer: Healthfirst QHP |
$129.93
|
| Rate for Payer: Humana Medicare |
$132.53
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$129.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$129.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$123.43
|
| Rate for Payer: Wellcare Medicare |
$123.43
|
|
|
HC INTRACRANIAL LIMITED STUDY - US HEAD DOPPLER LIMITED
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 93888
|
| Hospital Charge Code |
4029388801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 95024
|
| Hospital Charge Code |
9249502401
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC INTRACUTANEOUS TESTS W/ALLERGENIC EXTRACTS
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 95024
|
| Hospital Charge Code |
9249502401
|
|
Hospital Revenue Code
|
924
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$83.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC INTRALESIONAL CHEMO ADMIN,8+ LESN
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
3319640601
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC INTRALESIONAL CHEMO ADMIN,8+ LESN
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96406
|
| Hospital Charge Code |
3319640601
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$683.90 |
| 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 |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.43
|
| Rate for Payer: EmblemHealth Commercial |
$257.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| 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 |
$48.66
|
| 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 |
$316.00
|
| 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 INTRANASAL BIOPSY
|
Facility
|
IP
|
$4,086.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
3613010001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.00
|
|
|
HC INTRANASAL BIOPSY
|
Facility
|
OP
|
$4,086.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
3613010001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$3,064.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| 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 |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$1,809.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,809.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$99.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA
|
Facility
|
OP
|
$7,669.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
3614100801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$306.07 |
| Max. Negotiated Rate |
$5,751.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,962.45
|
| Rate for Payer: Aetna Government |
$3,962.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,773.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,773.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,773.72
|
| Rate for Payer: Brighton Health Commercial |
$5,751.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,962.45
|
| 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 |
$3,962.45
|
| Rate for Payer: EmblemHealth Commercial |
$3,962.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,566.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,368.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,526.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,962.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,526.58
|
| Rate for Payer: Group Health Inc Commercial |
$3,962.45
|
| Rate for Payer: Group Health Inc Medicare |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,394.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$306.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,368.08
|
| Rate for Payer: Healthfirst QHP |
$3,962.45
|
| Rate for Payer: Humana Medicare |
$4,041.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,962.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,962.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,764.33
|
| Rate for Payer: Wellcare Medicare |
$3,764.33
|
|
|
HC INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA
|
Facility
|
IP
|
$7,669.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
3614100801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,834.50 |
| Max. Negotiated Rate |
$3,834.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,834.50
|
|
|
HC INTRAORAL-PERIAPICAL-FIRST FILM
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT D0220
|
| Hospital Charge Code |
361D022001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC INTRAORAL-PERIAPICAL-FIRST FILM
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT D0220
|
| Hospital Charge Code |
361D022001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$109.73 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$107.58
|
| Rate for Payer: Aetna Government |
$107.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$75.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$75.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$75.31
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$107.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$107.58
|
| Rate for Payer: EmblemHealth Commercial |
$107.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$96.82
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$91.44
|
| Rate for Payer: Fidelis Essential Plan QHP |
$95.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$107.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$95.75
|
| Rate for Payer: Group Health Inc Commercial |
$107.58
|
| Rate for Payer: Group Health Inc Medicare |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$107.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$107.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$91.44
|
| Rate for Payer: Healthfirst QHP |
$107.58
|
| Rate for Payer: Humana Medicare |
$109.73
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$107.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$107.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$102.20
|
| Rate for Payer: Wellcare Medicare |
$102.20
|
|
|
HC INTRAVASCULAR NONCORANARY US, ADD'L VESSEL, ADD-ON
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
CPT 37253 TC
|
| Hospital Charge Code |
3613725301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$236.53 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$236.53
|
| Rate for Payer: Aetna Government |
$236.53
|
| Rate for Payer: Brighton Health Commercial |
$1,140.00
|
| 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 |
$760.00
|
| Rate for Payer: Group Health Inc Commercial |
$760.00
|
| Rate for Payer: Group Health Inc Medicare |
$532.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$760.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INTRAVASCULAR NONCORANARY US, ADD'L VESSEL, ADD-ON
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
CPT 37253 TC
|
| Hospital Charge Code |
3613725301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$760.00
|
|
|
HC INTRAVASCULAR NONCORANARY US, FIRST VESSEL, ADD-ON
|
Facility
|
OP
|
$2,536.00
|
|
|
Service Code
|
CPT 37252 TC
|
| Hospital Charge Code |
3613725201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.60 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,516.34
|
| Rate for Payer: Aetna Government |
$1,516.34
|
| Rate for Payer: Brighton Health Commercial |
$1,902.00
|
| 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 |
$1,268.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,268.00
|
| Rate for Payer: Group Health Inc Medicare |
$887.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,268.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,268.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INTRAVASCULAR NONCORANARY US, FIRST VESSEL, ADD-ON
|
Facility
|
IP
|
$2,536.00
|
|
|
Service Code
|
CPT 37252 TC
|
| Hospital Charge Code |
3613725201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,268.00 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,268.00
|
|
|
HC INTRINSIC FACTOR ANTIBODY - INTRINSIC FACTOR BLOCKING ANTIBODY
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
3028634001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.08
|
| Rate for Payer: Aetna Government |
$15.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.56
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.08
|
| Rate for Payer: EmblemHealth Commercial |
$15.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.57
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.42
|
| Rate for Payer: Group Health Inc Commercial |
$15.08
|
| Rate for Payer: Group Health Inc Medicare |
$15.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.47
|
| Rate for Payer: Healthfirst Essential Plan |
$25.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.08
|
| Rate for Payer: Healthfirst QHP |
$15.08
|
| Rate for Payer: Humana Medicare |
$15.38
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare Commercial |
$19.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.47
|
| Rate for Payer: Wellcare Medicare |
$13.57
|
|
|
HC INTRINSIC FACTOR ANTIBODY - INTRINSIC FACTOR BLOCKING ANTIBODY
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
3028634001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
