|
HC IRIDOTOMY/IRIDECTOMY BY LASER, PER SESSION
|
Facility
|
IP
|
$1,857.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
3616676101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$928.50 |
| Max. Negotiated Rate |
$928.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$928.50
|
|
|
HC IRIDOTOMY/IRIDECTOMY BY LASER, PER SESSION
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
3616676101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.49 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$670.29
|
| Rate for Payer: Aetna Government |
$670.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,536.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$682.93
|
| Rate for Payer: Amida Care Medicaid |
$682.93
|
| Rate for Payer: Brighton Health Commercial |
$1,392.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.29
|
| 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 |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$670.29
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$682.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,536.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,536.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.07
|
| Rate for Payer: Group Health Inc Commercial |
$670.29
|
| Rate for Payer: Group Health Inc Medicare |
$670.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.75
|
| Rate for Payer: Healthfirst QHP |
$1,113.17
|
| Rate for Payer: Humana Medicare |
$683.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: SOMOS Essential |
$1,536.59
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$751.21
|
| Rate for Payer: United Healthcare Medicaid |
$682.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Wellcare Medicare |
$636.78
|
|
|
HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
3018355001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.74
|
| Rate for Payer: Aetna Government |
$8.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.12
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.74
|
| Rate for Payer: EmblemHealth Commercial |
$8.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.78
|
| Rate for Payer: Group Health Inc Commercial |
$8.74
|
| Rate for Payer: Group Health Inc Medicare |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.74
|
| Rate for Payer: Healthfirst QHP |
$8.74
|
| Rate for Payer: Humana Medicare |
$8.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$11.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$7.87
|
|
|
HC IRON BINDING TEST - IRON AND IRON BINDING CAPACITY PANEL - SR OR PL
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
3018355001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC IRON BINDING TEST - IRON + TRANSFERRIN + TIBC
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
3018355002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.74
|
| Rate for Payer: Aetna Government |
$8.74
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.12
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.74
|
| Rate for Payer: EmblemHealth Commercial |
$8.74
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.74
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.78
|
| Rate for Payer: Group Health Inc Commercial |
$8.74
|
| Rate for Payer: Group Health Inc Medicare |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.74
|
| Rate for Payer: Healthfirst QHP |
$8.74
|
| Rate for Payer: Humana Medicare |
$8.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.74
|
| Rate for Payer: United Healthcare Commercial |
$11.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.74
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$7.87
|
|
|
HC IRON BINDING TEST - IRON + TRANSFERRIN + TIBC
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83550
|
| Hospital Charge Code |
3018355002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC IRRADIATION OF BLOOD PRODUCT, EACH UNIT
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
3008694501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.96
|
| Rate for Payer: Aetna Government |
$47.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.57
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.03
|
| Rate for Payer: Elderplan Medicare Advantage |
$47.96
|
| Rate for Payer: EmblemHealth Commercial |
$47.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$40.77
|
| Rate for Payer: Fidelis Essential Plan QHP |
$42.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$47.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$42.68
|
| Rate for Payer: Group Health Inc Commercial |
$47.96
|
| Rate for Payer: Group Health Inc Medicare |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.96
|
| Rate for Payer: Healthfirst QHP |
$47.96
|
| Rate for Payer: Humana Medicare |
$48.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$47.96
|
| Rate for Payer: United Healthcare Commercial |
$13.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$47.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$45.56
|
| Rate for Payer: Wellcare Medicare |
$43.16
|
|
|
HC IRRADIATION OF BLOOD PRODUCT, EACH UNIT
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86945
|
| Hospital Charge Code |
3008694501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC IRRIGAT CORPUS CAVERN,PRIAPISM
|
Facility
|
IP
|
$734.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
3615422001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.00 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$367.00
|
|
|
HC IRRIGAT CORPUS CAVERN,PRIAPISM
|
Facility
|
OP
|
$734.00
|
|
|
Service Code
|
CPT 54220
|
| Hospital Charge Code |
3615422001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.70 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$297.16
|
| Rate for Payer: Aetna Government |
$297.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$208.01
|
| Rate for Payer: Brighton Health Commercial |
$550.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.16
|
| 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 |
$297.16
|
| Rate for Payer: EmblemHealth Commercial |
$297.16
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.47
|
| Rate for Payer: Group Health Inc Commercial |
$297.16
|
| Rate for Payer: Group Health Inc Medicare |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.59
|
| Rate for Payer: Healthfirst QHP |
$297.16
|
| Rate for Payer: Humana Medicare |
$303.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.16
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$282.30
|
| Rate for Payer: Wellcare Medicare |
$282.30
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
3615170001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC IRRIGATION OF BLADDER
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
3615170001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$297.16
|
| Rate for Payer: Aetna Government |
$297.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$208.01
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$297.16
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$297.16
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$297.16
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.47
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$297.16
|
| Rate for Payer: Humana Medicare |
$303.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.16
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$282.30
|
| Rate for Payer: Wellcare Medicare |
$282.30
|
|
|
HC IRRIG IMPLANTED DRUG DELIVERY DEVICE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
3359652301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC IRRIG IMPLANTED DRUG DELIVERY DEVICE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
3359652301
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$683.90 |
| 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 |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| 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 |
$28.00
|
| 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 |
$316.00
|
| 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 ISLET CELL ANTIBODY - ANTI-ISLET CELL AB
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3028634101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.57
|
| Rate for Payer: Aetna Government |
$23.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.50
|
| Rate for Payer: Brighton Health Commercial |
$43.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$23.57
|
| Rate for Payer: EmblemHealth Commercial |
$23.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.98
|
| Rate for Payer: Group Health Inc Commercial |
$23.57
|
| Rate for Payer: Group Health Inc Medicare |
$23.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.57
|
| Rate for Payer: Healthfirst QHP |
$23.57
|
| Rate for Payer: Humana Medicare |
$24.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.57
|
| Rate for Payer: United Healthcare Commercial |
$25.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$21.21
|
|
|
HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3028634101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
|
|
HC ISLET CELL ANTIBODY - GAD-65 AUTOANTIBODY
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3028634102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.57
|
| Rate for Payer: Aetna Government |
$23.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16.50
|
| Rate for Payer: Brighton Health Commercial |
$43.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23.57
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$23.57
|
| Rate for Payer: EmblemHealth Commercial |
$23.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20.98
|
| Rate for Payer: Fidelis Medicare Advantage |
$23.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20.98
|
| Rate for Payer: Group Health Inc Commercial |
$23.57
|
| Rate for Payer: Group Health Inc Medicare |
$23.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Healthfirst Essential Plan |
$28.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$23.57
|
| Rate for Payer: Healthfirst QHP |
$23.57
|
| Rate for Payer: Humana Medicare |
$24.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23.57
|
| Rate for Payer: United Healthcare Commercial |
$25.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.63
|
| Rate for Payer: Wellcare Medicare |
$21.21
|
|
|
HC ISLET CELL ANTIBODY - GAD-65 AUTOANTIBODY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3028634102
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$29.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.00
|
|
|
HC IUD INSERTION
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3615830002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$21,008.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$67.24
|
| Rate for Payer: Aetna Government |
$67.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$472.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$472.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$210.08
|
| Rate for Payer: Amida Care Medicaid |
$210.08
|
| Rate for Payer: Brighton Health Commercial |
$73.50
|
| 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 |
$49.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$472.68
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$210.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$472.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$472.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.58
|
| Rate for Payer: Group Health Inc Commercial |
$49.00
|
| Rate for Payer: Group Health Inc Medicare |
$34.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$49.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,008.00
|
| Rate for Payer: Healthfirst Essential Plan |
$472.68
|
| Rate for Payer: Healthfirst QHP |
$342.43
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.08
|
| Rate for Payer: SOMOS Essential |
$472.68
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$472.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$231.09
|
| Rate for Payer: United Healthcare Medicaid |
$210.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$210.08
|
|
|
HC IUD INSERTION
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
3615830002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$49.00
|
|
|
HC IV INF,THERAPY,EA ADDL HR (SPEC DRUG)
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
2609636602
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$761.50 |
| 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 |
$761.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$338.44
|
| Rate for Payer: Amida Care Medicaid |
$338.44
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| 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 |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$761.50
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$338.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$761.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.36
|
| 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 |
$338.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Healthfirst Essential Plan |
$761.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$551.66
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: SOMOS Essential |
$761.50
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$761.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$372.28
|
| Rate for Payer: United Healthcare Medicaid |
$338.44
|
| 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 |
$338.44
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC IV INF,THERAPY,EA ADDL HR (SPEC DRUG)
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
2609636602
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
2609636001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.59 |
| 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 |
$35.59
|
| 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 IV INFUSION, HYDRATION, 31-60 MIN
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
2609636001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC IV INFUSION, HYDRATION, EA ADD HOUR
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
2609636101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
