|
HC LIGATION OF COMMON ILLIAC VEIN
|
Facility
|
OP
|
$3,327.00
|
|
|
Service Code
|
CPT 37660 TC
|
| Hospital Charge Code |
3613766001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,164.45 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,829.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,312.95
|
| Rate for Payer: Aetna Government |
$1,312.95
|
| Rate for Payer: Brighton Health Commercial |
$2,495.25
|
| 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 |
$1,663.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,663.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,164.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,663.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,663.50
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC LIGATION OF FERORAL VEIN
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 37650 TC
|
| Hospital Charge Code |
3613765001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC LIGATION OF FERORAL VEIN
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 37650 TC
|
| Hospital Charge Code |
3613765001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$573.58 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$573.58
|
| Rate for Payer: Aetna Government |
$573.58
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC LIMITED ORAL EVALUATION
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT D0140
|
| Hospital Charge Code |
361D014001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC LIMITED ORAL EVALUATION
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT D0140
|
| Hospital Charge Code |
361D014001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.25 |
| Max. Negotiated Rate |
$160.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.46
|
| Rate for Payer: Aetna Government |
$157.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.22
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.22
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.22
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$23.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$157.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.71
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.84
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.14
|
| Rate for Payer: Group Health Inc Commercial |
$157.46
|
| Rate for Payer: Group Health Inc Medicare |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.84
|
| Rate for Payer: Healthfirst QHP |
$157.46
|
| Rate for Payer: Humana Medicare |
$160.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.59
|
| Rate for Payer: Wellcare Medicare |
$149.59
|
|
|
HC LIPID PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
3018006101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.37
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.10
|
| Rate for Payer: Healthfirst Essential Plan |
$13.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$16.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.10
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
HC LIPID PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
3018006101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC LIPOPRO BLOOD, ELECTROPHOR/ QUANT - LIPOPROTEIN ELECTROPHORESIS
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
3018370001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC LIPOPRO BLOOD, ELECTROPHOR/ QUANT - LIPOPROTEIN ELECTROPHORESIS
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83700
|
| Hospital Charge Code |
3018370001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.26
|
| Rate for Payer: Aetna Government |
$11.26
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.88
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.26
|
| Rate for Payer: EmblemHealth Commercial |
$11.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.13
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.02
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.02
|
| Rate for Payer: Group Health Inc Commercial |
$11.26
|
| Rate for Payer: Group Health Inc Medicare |
$11.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.26
|
| Rate for Payer: Healthfirst QHP |
$11.26
|
| Rate for Payer: Humana Medicare |
$11.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare Commercial |
$14.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.70
|
| Rate for Payer: Wellcare Medicare |
$10.13
|
|
|
HC LIPOPROTEIN (A)
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
3018369501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| 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 |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.32
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Wellcare Medicare |
$12.89
|
|
|
HC LIPOPROTEIN (A)
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
3018369501
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC LIPOPROTEIN FRACTIONATION
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
3018369502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC LIPOPROTEIN FRACTIONATION
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
3018369502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.32
|
| Rate for Payer: Aetna Government |
$14.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.02
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.02
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.02
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.32
|
| 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 |
$14.32
|
| Rate for Payer: EmblemHealth Commercial |
$14.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.74
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.74
|
| Rate for Payer: Group Health Inc Commercial |
$14.32
|
| Rate for Payer: Group Health Inc Medicare |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.32
|
| Rate for Payer: Healthfirst QHP |
$14.32
|
| Rate for Payer: Humana Medicare |
$14.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.32
|
| Rate for Payer: United Healthcare Commercial |
$16.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Wellcare Medicare |
$12.89
|
|
|
HC LIVER AND SPLEEN IMAGING - NM LIVER SPLEEN
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78215 TC
|
| Hospital Charge Code |
3417821501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC LIVER AND SPLEEN IMAGING - NM LIVER SPLEEN
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78215 TC
|
| Hospital Charge Code |
3417821501
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$116.98 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.98
|
| Rate for Payer: Aetna Government |
$116.98
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$567.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$477.57
|
| Rate for Payer: EmblemHealth Commercial |
$165.37
|
| 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 |
$165.37
|
| Rate for Payer: Healthfirst Essential Plan |
$279.88
|
| Rate for Payer: United Healthcare Commercial |
$212.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$124.39
|
|
|
HC LIVER IMAGING - NM LIVER
|
Facility
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT 78201 TC
|
| Hospital Charge Code |
3417820101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,926.50 |
| Max. Negotiated Rate |
$1,926.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,926.50
|
|
|
HC LIVER IMAGING - NM LIVER
|
Facility
|
OP
|
$3,853.00
|
|
|
Service Code
|
CPT 78201 TC
|
| Hospital Charge Code |
3417820101
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$114.41 |
| Max. Negotiated Rate |
$2,889.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.41
|
| Rate for Payer: Aetna Government |
$114.41
|
| Rate for Payer: Brighton Health Commercial |
$2,889.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$567.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$477.57
|
| Rate for Payer: EmblemHealth Commercial |
$163.27
|
| Rate for Payer: Group Health Inc Commercial |
$1,926.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,348.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,926.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,926.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$163.27
|
| Rate for Payer: Healthfirst Essential Plan |
$284.13
|
| Rate for Payer: United Healthcare Commercial |
$212.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$126.28
|
|
|
HC LIVER IMAGING WITH FLOW - NM LIVER WITH VASCULAR FLOW
|
Facility
|
OP
|
$3,853.00
|
|
|
Service Code
|
CPT 78202 TC
|
| Hospital Charge Code |
3417820201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$122.14 |
| Max. Negotiated Rate |
$2,889.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,119.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.14
|
| Rate for Payer: Aetna Government |
$122.14
|
| Rate for Payer: Brighton Health Commercial |
$2,889.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$567.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$477.57
|
| Rate for Payer: EmblemHealth Commercial |
$179.69
|
| Rate for Payer: Group Health Inc Commercial |
$1,926.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,348.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,926.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,926.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.69
|
| Rate for Payer: Healthfirst Essential Plan |
$333.47
|
| Rate for Payer: United Healthcare Commercial |
$212.10
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$148.21
|
|
|
HC LIVER IMAGING WITH FLOW - NM LIVER WITH VASCULAR FLOW
|
Facility
|
IP
|
$3,853.00
|
|
|
Service Code
|
CPT 78202 TC
|
| Hospital Charge Code |
3417820201
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,926.50 |
| Max. Negotiated Rate |
$1,926.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,926.50
|
|
|
HC LOMBARD TEST
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 92700
|
| Hospital Charge Code |
4719270001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC LOMBARD TEST
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 92700
|
| Hospital Charge Code |
4719270001
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$55.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$29.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.43
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$28.42
|
|
|
HC LOUDNESS BALANCE TEST
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
4719256201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC LOUDNESS BALANCE TEST
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
4719256201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.07 |
| Max. Negotiated Rate |
$388.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| Rate for Payer: Group Health Inc Commercial |
$380.47
|
| Rate for Payer: Group Health Inc Medicare |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$380.47
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC LOW DOSE CT FOR LUNG CANCER SCREENING
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
3527127101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
|
HC LOW DOSE CT FOR LUNG CANCER SCREENING
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
3527127101
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.72 |
| Max. Negotiated Rate |
$264.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$104.86
|
| Rate for Payer: Aetna Government |
$104.86
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$192.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$163.88
|
| Rate for Payer: EmblemHealth Commercial |
$93.69
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.69
|
| Rate for Payer: Healthfirst Essential Plan |
$264.46
|
| Rate for Payer: United Healthcare Commercial |
$64.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$117.54
|
|
