|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG/IGM
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3028673803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.24
|
| Rate for Payer: Healthfirst Essential Plan |
$29.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGG/IGM
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3028673803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3028673801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.24
|
| Rate for Payer: Aetna Government |
$13.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.27
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.27
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.27
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.24
|
| Rate for Payer: EmblemHealth Commercial |
$13.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.25
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.78
|
| Rate for Payer: Group Health Inc Commercial |
$13.24
|
| Rate for Payer: Group Health Inc Medicare |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.24
|
| Rate for Payer: Healthfirst Essential Plan |
$29.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.24
|
| Rate for Payer: Healthfirst QHP |
$13.24
|
| Rate for Payer: Humana Medicare |
$13.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare Commercial |
$16.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13.24
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
3028673801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
3018387301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$21.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.50
|
|
|
HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
3018387301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.20
|
| Rate for Payer: Aetna Government |
$17.20
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.04
|
| Rate for Payer: Brighton Health Commercial |
$32.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.20
|
| Rate for Payer: EmblemHealth Commercial |
$17.20
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.20
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.31
|
| Rate for Payer: Group Health Inc Commercial |
$17.20
|
| Rate for Payer: Group Health Inc Medicare |
$17.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17.20
|
| Rate for Payer: Healthfirst QHP |
$17.20
|
| Rate for Payer: Humana Medicare |
$17.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.20
|
| Rate for Payer: United Healthcare Commercial |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.34
|
| Rate for Payer: Wellcare Medicare |
$15.48
|
|
|
HC MYELOGRAPHY CERV SPINE - FL CERVICAL SPINE MYELOGRAM
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3207224001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.59 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.59
|
| Rate for Payer: Aetna Government |
$40.59
|
| Rate for Payer: Brighton Health Commercial |
$1,546.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,068.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$899.03
|
| Rate for Payer: EmblemHealth Commercial |
$71.47
|
| Rate for Payer: Group Health Inc Commercial |
$1,031.00
|
| Rate for Payer: Group Health Inc Medicare |
$721.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,031.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.47
|
| Rate for Payer: Healthfirst Essential Plan |
$210.01
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$93.34
|
|
|
HC MYELOGRAPHY CERV SPINE - FL CERVICAL SPINE MYELOGRAM
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3207224001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,031.00 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
|
|
HC MYELOGRAPHY LUMBAR SPINE - FL LUMBAR SPINE MYELOGRAM
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3207226501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.19
|
| Rate for Payer: Aetna Government |
$39.19
|
| Rate for Payer: Brighton Health Commercial |
$1,546.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,068.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$899.03
|
| Rate for Payer: EmblemHealth Commercial |
$71.82
|
| Rate for Payer: Group Health Inc Commercial |
$1,031.00
|
| Rate for Payer: Group Health Inc Medicare |
$721.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,031.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$71.82
|
| Rate for Payer: Healthfirst Essential Plan |
$200.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$89.04
|
|
|
HC MYELOGRAPHY LUMBAR SPINE - FL LUMBAR SPINE MYELOGRAM
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3207226501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,031.00 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
|
|
HC MYELOGRAPHY OF ENTIRE SPINE - FL CERVICAL THORACIC SPINE MYELOGRAM
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3207227001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.72
|
| Rate for Payer: Aetna Government |
$46.72
|
| Rate for Payer: Brighton Health Commercial |
$1,546.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,068.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$899.03
|
| Rate for Payer: EmblemHealth Commercial |
$90.68
|
| Rate for Payer: Group Health Inc Commercial |
$1,031.00
|
| Rate for Payer: Group Health Inc Medicare |
$721.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,031.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$90.68
|
| Rate for Payer: Healthfirst Essential Plan |
$470.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$209.04
|
|
|
HC MYELOGRAPHY OF ENTIRE SPINE - FL CERVICAL THORACIC SPINE MYELOGRAM
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3207227001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,031.00 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
|
|
HC MYELOGRAPHY THORAX SPINE - FL THORACIC SPINE MYELOGRAM
|
Facility
|
OP
|
$2,062.00
|
|
|
Service Code
|
CPT 72255 TC
|
| Hospital Charge Code |
3207225501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$1,546.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,134.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.75
|
| Rate for Payer: Aetna Government |
$39.75
|
| Rate for Payer: Brighton Health Commercial |
$1,546.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,068.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$899.03
|
| Rate for Payer: EmblemHealth Commercial |
$66.58
|
| Rate for Payer: Group Health Inc Commercial |
$1,031.00
|
| Rate for Payer: Group Health Inc Medicare |
$721.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,031.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.58
|
| Rate for Payer: Healthfirst Essential Plan |
$197.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$87.62
|
|
|
HC MYELOGRAPHY THORAX SPINE - FL THORACIC SPINE MYELOGRAM
|
Facility
|
IP
|
$2,062.00
|
|
|
Service Code
|
CPT 72255 TC
|
| Hospital Charge Code |
3207225501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,031.00 |
| Max. Negotiated Rate |
$1,031.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,031.00
|
|
|
HC MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
3615814001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
|
HC MYOMECTOMY 1-4,W/TOT 250GMS/<,ABD APPRCH
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 58140
|
| Hospital Charge Code |
3615814001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,067.58 |
| Max. Negotiated Rate |
$6,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,664.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,147.09
|
| Rate for Payer: Aetna Government |
$1,147.09
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$4,240.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,240.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,968.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,240.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,067.58
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
3615814601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
|
HC MYOMECTOMY 5/>,TOT>250 GMS,ABD APPRCH
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 58146
|
| Hospital Charge Code |
3615814601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,336.35 |
| Max. Negotiated Rate |
$6,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,664.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,413.61
|
| Rate for Payer: Aetna Government |
$1,413.61
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$4,240.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,240.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,968.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,240.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,336.35
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC MYRINGOTOMY
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
5106942001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$780.00 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$141.03
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 MYRINGOTOMY
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
5106942001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC NASAL ENDOSCOPY,DX
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
3613123101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.79 |
| 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 |
$104.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$73.79
|
| 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 NASAL ENDOSCOPY,DX
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
3613123101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.00 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.00
|
|
|
HC NASAL FUNCTION STUDY
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 92512
|
| Hospital Charge Code |
5109251201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$421.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$29.96
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$399.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 NASAL FUNCTION STUDY
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 92512
|
| Hospital Charge Code |
5109251201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC NASAL/SINUS ENDOSCOPY,BX/RMV POLYP/DEBRID
|
Facility
|
OP
|
$4,332.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
3613123701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$3,249.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$185.10
|
| 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
|
|
