|
HC K FLOW/FUNCT IMAGE W/DRUG - NM KIDNEY FLOW/FUNCT W PHARMACOL INTER
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78708 TC
|
| Hospital Charge Code |
3417870803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$79.63 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.63
|
| Rate for Payer: Aetna Government |
$79.63
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$687.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$579.04
|
| Rate for Payer: EmblemHealth Commercial |
$126.94
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.94
|
| Rate for Payer: Healthfirst Essential Plan |
$260.80
|
| Rate for Payer: United Healthcare Commercial |
$257.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$115.91
|
|
|
HC K FLOW/FUNCT IMAGE W/DRUG - NM KIDNEY FLOW/FUNCT W PHARMACOL INTER
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78708 TC
|
| Hospital Charge Code |
3417870803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC K FLOW/FUNCT IMAGE W/O DRUG - NM KIDNEY FLOW/FUNCT WO PHARMACOL INT
|
Facility
|
OP
|
$1,429.00
|
|
|
Service Code
|
CPT 78707 TC
|
| Hospital Charge Code |
3417870701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$127.76 |
| Max. Negotiated Rate |
$1,071.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$785.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.76
|
| Rate for Payer: Aetna Government |
$127.76
|
| Rate for Payer: Brighton Health Commercial |
$1,071.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$687.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$579.04
|
| Rate for Payer: EmblemHealth Commercial |
$177.60
|
| Rate for Payer: Group Health Inc Commercial |
$714.50
|
| Rate for Payer: Group Health Inc Medicare |
$500.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$714.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$177.60
|
| Rate for Payer: Healthfirst Essential Plan |
$345.15
|
| Rate for Payer: United Healthcare Commercial |
$257.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$153.40
|
|
|
HC K FLOW/FUNCT IMAGE W/O DRUG - NM KIDNEY FLOW/FUNCT WO PHARMACOL INT
|
Facility
|
IP
|
$1,429.00
|
|
|
Service Code
|
CPT 78707 TC
|
| Hospital Charge Code |
3417870701
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$714.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$714.50
|
|
|
HC KIDNEY IMAGING MORPHOL - NM KIDNEY CORTEX
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78700 TC
|
| Hospital Charge Code |
3417870001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$102.93 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$102.93
|
| Rate for Payer: Aetna Government |
$102.93
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$687.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$579.04
|
| Rate for Payer: EmblemHealth Commercial |
$143.36
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$143.36
|
| Rate for Payer: Healthfirst Essential Plan |
$256.59
|
| Rate for Payer: United Healthcare Commercial |
$257.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$114.04
|
|
|
HC KIDNEY IMAGING MORPHOL - NM KIDNEY CORTEX
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78700 TC
|
| Hospital Charge Code |
3417870001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC LAB PATHOLOGY CONSULT-LTD - ADDITIONAL CHARGE
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 80500
|
| Hospital Charge Code |
3018050002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC LAB PATHOLOGY CONSULT-LTD - ADDITIONAL CHARGE
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 80500
|
| Hospital Charge Code |
3018050002
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$76.00
|
| Rate for Payer: Aetna Government |
$76.00
|
| Rate for Payer: Brighton Health Commercial |
$114.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.17
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.66
|
| Rate for Payer: EmblemHealth Commercial |
$76.00
|
| Rate for Payer: Group Health Inc Commercial |
$76.00
|
| Rate for Payer: Group Health Inc Medicare |
$53.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.00
|
|
|
HC LAB TEST OF ANTIGEN, ANTIBODY
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3008352001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.27
|
| Rate for Payer: Aetna Government |
$17.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.09
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.27
|
| Rate for Payer: EmblemHealth Commercial |
$17.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.54
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.37
|
| Rate for Payer: Group Health Inc Commercial |
$17.27
|
| Rate for Payer: Group Health Inc Medicare |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.27
|
| Rate for Payer: Healthfirst QHP |
$17.27
|
| Rate for Payer: Humana Medicare |
$17.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.41
|
| Rate for Payer: Wellcare Medicare |
$15.54
|
|
|
HC LAB TEST OF ANTIGEN, ANTIBODY
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
3008352001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3018361502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.04
|
| Rate for Payer: Aetna Government |
$6.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.23
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.04
|
| Rate for Payer: EmblemHealth Commercial |
$6.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.04
|
| Rate for Payer: Healthfirst QHP |
$6.04
|
| Rate for Payer: Humana Medicare |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare Commercial |
$7.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.44
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3018361502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE, CSF
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3018361503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE, CSF
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3018361503
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.04
|
| Rate for Payer: Aetna Government |
$6.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.23
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.04
|
| Rate for Payer: EmblemHealth Commercial |
$6.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.04
|
| Rate for Payer: Healthfirst QHP |
$6.04
|
| Rate for Payer: Humana Medicare |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare Commercial |
$7.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.44
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE FL
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3018361501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC LACTATE (LD) (LDH) ENZYME - LACTATE DEHYDROGENASE FL
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3018361501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.04
|
| Rate for Payer: Aetna Government |
$6.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.23
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.04
|
| Rate for Payer: EmblemHealth Commercial |
$6.04
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Healthfirst Essential Plan |
$11.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.04
|
| Rate for Payer: Healthfirst QHP |
$6.04
|
| Rate for Payer: Humana Medicare |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare Commercial |
$7.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.08
|
| Rate for Payer: Wellcare Medicare |
$5.44
|
|
|
HC LACTOFERRIN, FECAL, QUANTITATIVE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
3018363101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$36.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.63
|
| Rate for Payer: Aetna Government |
$19.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.74
|
| Rate for Payer: Brighton Health Commercial |
$36.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.63
|
| Rate for Payer: EmblemHealth Commercial |
$19.63
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.47
|
| Rate for Payer: Group Health Inc Commercial |
$19.63
|
| Rate for Payer: Group Health Inc Medicare |
$19.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.39
|
| Rate for Payer: Healthfirst Essential Plan |
$25.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.63
|
| Rate for Payer: Healthfirst QHP |
$19.63
|
| Rate for Payer: Humana Medicare |
$20.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.63
|
| Rate for Payer: United Healthcare Commercial |
$24.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.39
|
| Rate for Payer: Wellcare Medicare |
$17.67
|
|
|
HC LACTOFERRIN, FECAL, QUANTITATIVE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 83631
|
| Hospital Charge Code |
3018363101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
|
|
HC LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS
|
Facility
|
IP
|
$27,255.00
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
3615857001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,627.50 |
| Max. Negotiated Rate |
$13,627.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,627.50
|
|
|
HC LAPAROSCOPY W TOT HYSTERECT UTERUS 250 GRAM OR LESS
|
Facility
|
OP
|
$27,255.00
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
3615857001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$938.89 |
| Max. Negotiated Rate |
$20,441.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,720.64
|
| Rate for Payer: Aetna Government |
$12,720.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,904.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,904.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,904.45
|
| Rate for Payer: Brighton Health Commercial |
$20,441.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,720.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,720.64
|
| Rate for Payer: EmblemHealth Commercial |
$12,720.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,448.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,812.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,321.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,720.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,321.37
|
| Rate for Payer: Group Health Inc Commercial |
$12,720.64
|
| Rate for Payer: Group Health Inc Medicare |
$12,720.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,720.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,896.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$938.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,812.54
|
| Rate for Payer: Healthfirst QHP |
$12,720.64
|
| Rate for Payer: Humana Medicare |
$12,975.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,720.64
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,720.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,720.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,084.61
|
| Rate for Payer: Wellcare Medicare |
$12,084.61
|
|
|
HC LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY
|
Facility
|
OP
|
$27,255.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
3615857101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,054.54 |
| Max. Negotiated Rate |
$20,441.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,720.64
|
| Rate for Payer: Aetna Government |
$12,720.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,904.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,904.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,904.45
|
| Rate for Payer: Brighton Health Commercial |
$20,441.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,720.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$12,720.64
|
| Rate for Payer: EmblemHealth Commercial |
$12,720.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,448.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,812.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,321.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,720.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,321.37
|
| Rate for Payer: Group Health Inc Commercial |
$12,720.64
|
| Rate for Payer: Group Health Inc Medicare |
$12,720.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,720.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,896.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,054.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,812.54
|
| Rate for Payer: Healthfirst QHP |
$12,720.64
|
| Rate for Payer: Humana Medicare |
$12,975.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,720.64
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,720.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,720.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,084.61
|
| Rate for Payer: Wellcare Medicare |
$12,084.61
|
|
|
HC LAPAROSCOPY W TOT HYSTERECTUTERUS <=250 GRAM W TUBE/OVARY
|
Facility
|
IP
|
$27,255.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
3615857101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13,627.50 |
| Max. Negotiated Rate |
$13,627.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,627.50
|
|
|
HC LAP,DIAGNOSTIC ABDOMEN
|
Facility
|
OP
|
$15,632.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
3614932001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.17 |
| Max. Negotiated Rate |
$11,724.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,128.54
|
| Rate for Payer: Aetna Government |
$7,128.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,989.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,989.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,989.98
|
| Rate for Payer: Brighton Health Commercial |
$11,724.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,128.54
|
| 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 |
$7,128.54
|
| Rate for Payer: EmblemHealth Commercial |
$7,128.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,415.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,059.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,344.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,128.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,344.40
|
| Rate for Payer: Group Health Inc Commercial |
$7,128.54
|
| Rate for Payer: Group Health Inc Medicare |
$7,128.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,128.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,860.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$395.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,059.26
|
| Rate for Payer: Healthfirst QHP |
$7,128.54
|
| Rate for Payer: Humana Medicare |
$7,271.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,128.54
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,128.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,128.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,772.11
|
| Rate for Payer: Wellcare Medicare |
$6,772.11
|
|
|
HC LAP,DIAGNOSTIC ABDOMEN
|
Facility
|
IP
|
$15,632.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
3614932001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,816.00 |
| Max. Negotiated Rate |
$7,816.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,816.00
|
|
|
HC LAP,DX SURGICAL ABD W/BIOPSY
|
Facility
|
OP
|
$15,632.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
3614932101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.70 |
| Max. Negotiated Rate |
$11,724.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7,128.54
|
| Rate for Payer: Aetna Government |
$7,128.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,989.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,989.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,989.98
|
| Rate for Payer: Brighton Health Commercial |
$11,724.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7,128.54
|
| 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 |
$7,128.54
|
| Rate for Payer: EmblemHealth Commercial |
$7,128.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,415.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6,059.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,344.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$7,128.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,344.40
|
| Rate for Payer: Group Health Inc Commercial |
$7,128.54
|
| Rate for Payer: Group Health Inc Medicare |
$7,128.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,128.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,860.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$409.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6,059.26
|
| Rate for Payer: Healthfirst QHP |
$7,128.54
|
| Rate for Payer: Humana Medicare |
$7,271.11
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7,128.54
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,128.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7,128.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,772.11
|
| Rate for Payer: Wellcare Medicare |
$6,772.11
|
|
