|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE LIVER BIOPSY
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700282
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$915.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.91
|
| Rate for Payer: Aetna Government |
$50.91
|
| Rate for Payer: Brighton Health Commercial |
$858.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$915.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$777.92
|
| Rate for Payer: EmblemHealth Commercial |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$572.00
|
| Rate for Payer: Group Health Inc Medicare |
$400.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.74
|
| Rate for Payer: Healthfirst Essential Plan |
$109.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.53
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE PLACEMENT
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED NEEDLE PLACEMENT
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700288
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$915.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.91
|
| Rate for Payer: Aetna Government |
$50.91
|
| Rate for Payer: Brighton Health Commercial |
$858.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$915.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$777.92
|
| Rate for Payer: EmblemHealth Commercial |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$572.00
|
| Rate for Payer: Group Health Inc Medicare |
$400.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.74
|
| Rate for Payer: Healthfirst Essential Plan |
$109.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.53
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED PLEURA NEEDLE BIOPSY
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700279
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED PLEURA NEEDLE BIOPSY
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700279
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$915.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.91
|
| Rate for Payer: Aetna Government |
$50.91
|
| Rate for Payer: Brighton Health Commercial |
$858.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$915.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$777.92
|
| Rate for Payer: EmblemHealth Commercial |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$572.00
|
| Rate for Payer: Group Health Inc Medicare |
$400.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.74
|
| Rate for Payer: Healthfirst Essential Plan |
$109.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.53
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - US GUIDED ASPIR OF ABSCESS, HEMA, CYST
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$572.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
|
|
HC NEEDLE LOCALIZATION BY XRAY - US GUIDED ASPIR OF ABSCESS, HEMA, CYST
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 77002 TC
|
| Hospital Charge Code |
3207700201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.53 |
| Max. Negotiated Rate |
$915.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$629.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$50.91
|
| Rate for Payer: Aetna Government |
$50.91
|
| Rate for Payer: Brighton Health Commercial |
$858.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$915.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$777.92
|
| Rate for Payer: EmblemHealth Commercial |
$91.74
|
| Rate for Payer: Group Health Inc Commercial |
$572.00
|
| Rate for Payer: Group Health Inc Medicare |
$400.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$572.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$572.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$91.74
|
| Rate for Payer: Healthfirst Essential Plan |
$109.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$48.53
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
3619760501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.16 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$423.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$359.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
3619760501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7619760601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$773.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$531.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$773.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| 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 |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
7619760601
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
7619760701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME </= 50 SQ CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
7619760701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$23.81 |
| Max. Negotiated Rate |
$773.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$531.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$773.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| 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 |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
7619760801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC NEG PRESSURE WOUND THERAPY NON DME >50 SQ CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
7619760801
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$773.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$531.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$773.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$657.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| 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 |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$488.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - IMMUNOGLOBULIN FREE LT CHAINS BLOOD
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
3018388301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - IMMUNOGLOBULIN FREE LT CHAINS BLOOD
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
3018388301
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna Government |
$13.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.52
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$13.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.10
|
| Rate for Payer: Group Health Inc Commercial |
$13.60
|
| Rate for Payer: Group Health Inc Medicare |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.60
|
| Rate for Payer: Healthfirst QHP |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.92
|
| Rate for Payer: Wellcare Medicare |
$12.24
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - KAPPA / LAMBDA LIGHT CHAINS, URINE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
3018388302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$25.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.60
|
| Rate for Payer: Aetna Government |
$13.60
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.52
|
| Rate for Payer: Brighton Health Commercial |
$25.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.60
|
| Rate for Payer: EmblemHealth Commercial |
$13.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.60
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.10
|
| Rate for Payer: Group Health Inc Commercial |
$13.60
|
| Rate for Payer: Group Health Inc Medicare |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.60
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.60
|
| Rate for Payer: Healthfirst QHP |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare Commercial |
$17.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.92
|
| Rate for Payer: Wellcare Medicare |
$12.24
|
|
|
HC NEPHELOMETRY, NOT SPECIFIED - KAPPA / LAMBDA LIGHT CHAINS, URINE
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
3018388302
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.00
|
|
|
HC NERVE BLOCK INJ SPINAL ACCESSOR
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
3616499901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$360.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC NERVE BLOCK INJ SPINAL ACCESSOR
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 64999
|
| Hospital Charge Code |
3616499901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
9189611601
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$646.37 |
| 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 |
$646.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$646.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$287.27
|
| Rate for Payer: Amida Care Medicaid |
$287.27
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$287.27
|
| 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 |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$646.37
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$287.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$287.27
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$646.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.37
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$301.64
|
| 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 |
$287.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.27
|
| Rate for Payer: Healthfirst Essential Plan |
$646.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$468.26
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$287.27
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$646.37
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$646.37
|
| Rate for Payer: Optum Medicaid |
$1.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$287.27
|
| Rate for Payer: SOMOS Essential |
$646.37
|
| Rate for Payer: United Healthcare Commercial |
$383.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$646.37
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$316.00
|
| Rate for Payer: United Healthcare Medicaid |
$287.27
|
| 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 |
$287.27
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC NEUROBEHAVIORAL STATUS EXAM
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 96116
|
| Hospital Charge Code |
9189611601
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 95937 TC
|
| Hospital Charge Code |
9229593701
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC NEUROMUSCULAR JUNCTION TEST
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 95937 TC
|
| Hospital Charge Code |
9229593701
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.12
|
| Rate for Payer: Aetna Government |
$42.12
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: EmblemHealth Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Commercial |
$209.50
|
| Rate for Payer: Group Health Inc Medicare |
$146.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.03
|
| Rate for Payer: United Healthcare Commercial |
$120.00
|
|
