|
HC LAP,DX SURGICAL ABD W/BIOPSY
|
Facility
|
IP
|
$15,632.00
|
|
|
Service Code
|
CPT 49321
|
| Hospital Charge Code |
3614932101
|
|
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, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G
|
Facility
|
OP
|
$27,255.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
3615854201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$960.68 |
| 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 |
$960.68
|
| 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 LAP, SUPRACERVIAL HYSTERECTOMY W/ TUBE&OV, <250G
|
Facility
|
IP
|
$27,255.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
3615854201
|
|
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,VAG HYST,UTERUS >250GMS,SALP-OOPH
|
Facility
|
IP
|
$27,255.00
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
3615855401
|
|
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,VAG HYST,UTERUS >250GMS,SALP-OOPH
|
Facility
|
OP
|
$27,255.00
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
3615855401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,507.90 |
| 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 |
$1,507.90
|
| 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 LAP,VAG HYST,UTERUS 250GMS/<,SALP-OOPH
|
Facility
|
IP
|
$27,255.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
3615855201
|
|
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,VAG HYST,UTERUS 250GMS/<,SALP-OOPH
|
Facility
|
OP
|
$27,255.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
3615855201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,138.34 |
| 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 |
$1,138.34
|
| 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 LARYNGOSCOPY,DIRCT,OP,BIOPSY
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 31535
|
| Hospital Charge Code |
3613153501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,447.50 |
| Max. Negotiated Rate |
$4,447.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,447.50
|
|
|
HC LARYNGOSCOPY,DIRCT,OP,BIOPSY
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 31535
|
| Hospital Charge Code |
3613153501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.10 |
| Max. Negotiated Rate |
$6,671.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,504.79
|
| Rate for Payer: Aetna Government |
$4,504.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,153.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,153.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,153.35
|
| Rate for Payer: Brighton Health Commercial |
$6,671.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,504.79
|
| 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 |
$4,504.79
|
| Rate for Payer: EmblemHealth Commercial |
$4,504.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,054.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,829.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,009.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,504.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,009.26
|
| Rate for Payer: Group Health Inc Commercial |
$4,504.79
|
| Rate for Payer: Group Health Inc Medicare |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,504.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,610.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,829.07
|
| Rate for Payer: Healthfirst QHP |
$4,504.79
|
| Rate for Payer: Humana Medicare |
$4,594.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,504.79
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,504.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,504.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,279.55
|
| Rate for Payer: Wellcare Medicare |
$4,279.55
|
|
|
HC LARYNGOSCOPY,DIRECT,DIAGNOSTIC
|
Facility
|
IP
|
$4,332.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
3613152501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,166.00 |
| Max. Negotiated Rate |
$2,166.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,166.00
|
|
|
HC LARYNGOSCOPY,DIRECT,DIAGNOSTIC
|
Facility
|
OP
|
$4,332.00
|
|
|
Service Code
|
CPT 31525
|
| Hospital Charge Code |
3613152501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$184.19 |
| Max. Negotiated Rate |
$3,249.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,106.99
|
| Rate for Payer: Aetna Government |
$2,106.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,474.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,474.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,474.89
|
| Rate for Payer: Brighton Health Commercial |
$3,249.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,106.99
|
| 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 |
$2,106.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,106.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,896.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,790.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,875.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,106.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,875.22
|
| Rate for Payer: Group Health Inc Commercial |
$2,106.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,106.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,106.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$792.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,790.94
|
| Rate for Payer: Healthfirst QHP |
$2,106.99
|
| Rate for Payer: Humana Medicare |
$2,149.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,106.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,106.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,106.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,001.64
|
| Rate for Payer: Wellcare Medicare |
$2,001.64
|
|
|
HC LARYNGOSCOPY DIRECT FOR ASPIRATION
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
3613151501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
|
|
HC LARYNGOSCOPY DIRECT FOR ASPIRATION
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
3613151501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$474.44
|
| Rate for Payer: Aetna Government |
$474.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$332.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$332.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$332.11
|
| Rate for Payer: Brighton Health Commercial |
$858.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$474.44
|
| 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 |
$474.44
|
| Rate for Payer: EmblemHealth Commercial |
$474.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$427.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$403.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$422.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$474.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$422.25
|
| Rate for Payer: Group Health Inc Commercial |
$474.44
|
| Rate for Payer: Group Health Inc Medicare |
$474.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$403.27
|
| Rate for Payer: Healthfirst QHP |
$474.44
|
| Rate for Payer: Humana Medicare |
$483.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$474.44
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$474.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$474.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$450.72
|
| Rate for Payer: Wellcare Medicare |
$450.72
|
|
|
HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
3613157502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.00
|
|
|
HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
3613157502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$237.20
|
| Rate for Payer: Aetna Government |
$237.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$166.04
|
| Rate for Payer: Brighton Health Commercial |
$343.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.20
|
| 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 |
$237.20
|
| Rate for Payer: EmblemHealth Commercial |
$237.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.11
|
| Rate for Payer: Group Health Inc Commercial |
$237.20
|
| Rate for Payer: Group Health Inc Medicare |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.62
|
| Rate for Payer: Healthfirst QHP |
$237.20
|
| Rate for Payer: Humana Medicare |
$241.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.20
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.34
|
| Rate for Payer: Wellcare Medicare |
$225.34
|
|
|
HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
3613157501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.00 |
| Max. Negotiated Rate |
$229.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.00
|
|
|
HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
3613157501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$237.20
|
| Rate for Payer: Aetna Government |
$237.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$166.04
|
| Rate for Payer: Brighton Health Commercial |
$343.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.20
|
| 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 |
$237.20
|
| Rate for Payer: EmblemHealth Commercial |
$237.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.11
|
| Rate for Payer: Group Health Inc Commercial |
$237.20
|
| Rate for Payer: Group Health Inc Medicare |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.62
|
| Rate for Payer: Healthfirst QHP |
$237.20
|
| Rate for Payer: Humana Medicare |
$241.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.20
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.34
|
| Rate for Payer: Wellcare Medicare |
$225.34
|
|
|
HC LARYNGOSCOPY,INDIRECT,DX
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
3613150501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.00
|
|
|
HC LARYNGOSCOPY,INDIRECT,DX
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
3613150501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$57.17 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$237.20
|
| Rate for Payer: Aetna Government |
$237.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$166.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$166.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$166.04
|
| Rate for Payer: Brighton Health Commercial |
$355.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$237.20
|
| 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 |
$237.20
|
| Rate for Payer: EmblemHealth Commercial |
$237.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$201.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$211.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$237.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$211.11
|
| Rate for Payer: Group Health Inc Commercial |
$237.20
|
| Rate for Payer: Group Health Inc Medicare |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$63.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$57.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$201.62
|
| Rate for Payer: Healthfirst QHP |
$237.20
|
| Rate for Payer: Humana Medicare |
$241.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$237.20
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$237.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$237.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$225.34
|
| Rate for Payer: Wellcare Medicare |
$225.34
|
|
|
HC LASER IRIDOTOMY-IRIDECTOMY
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
5106676101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.50
|
|
|
HC LASER IRIDOTOMY-IRIDECTOMY
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 66761
|
| Hospital Charge Code |
5106676101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.49 |
| Max. Negotiated Rate |
$1,536.59 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.80
|
| 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 |
$222.00
|
| 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 LASER SURGERY OF EYE
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 65855
|
| Hospital Charge Code |
5106585501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.50
|
|
|
HC LASER SURGERY OF EYE
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 65855
|
| Hospital Charge Code |
5106585501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.68 |
| Max. Negotiated Rate |
$1,536.59 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$682.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.68
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.80
|
| 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 |
$222.00
|
| 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 LAVAGE BY CANNULATION
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
3613100001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$462.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| 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 |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$283.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| Rate for Payer: Group Health Inc Commercial |
$283.73
|
| Rate for Payer: Group Health Inc Medicare |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC LAVAGE BY CANNULATION
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 31000
|
| Hospital Charge Code |
3613100001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
