|
HC OPHTHALMOLOGICAL SERVICES - COMPREHENSIVE, NEW PT
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 92002
|
| Hospital Charge Code |
5109200201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$197.50 |
| Max. Negotiated Rate |
$197.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$197.50
|
|
|
HC OPHTHALMOLOGICAL SERVICES - COMPREHENSIVE, NEW PT
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 92002
|
| Hospital Charge Code |
5109200201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.63 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.25
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$48.63
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 OPHTHALMOLOGICAL SERVICES - INTERMEDIATE, NEW PT
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 92004
|
| Hospital Charge Code |
5109200401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$179.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$179.00
|
|
|
HC OPHTHALMOLOGICAL SERVICES - INTERMEDIATE, NEW PT
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 92004
|
| Hospital Charge Code |
5109200401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$196.90
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.10
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 OPSCPY EXTENDED RTA DRAIN UNI/BI
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 92201
|
| Hospital Charge Code |
9209220101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC OPSCPY EXTENDED RTA DRAIN UNI/BI
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 92201
|
| Hospital Charge Code |
9209220101
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$24.72 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC OPSCPY EXTEND ON/MAC DRAW
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 92202
|
| Hospital Charge Code |
9209220201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC OPSCPY EXTEND ON/MAC DRAW
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 92202
|
| Hospital Charge Code |
9209220201
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$132.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$132.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$112.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC ORAL ADMIN OF SUBOXONE 12-3MG
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003305
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 12-3MG
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003305
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 2-0.5MG
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003302
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 2-0.5MG
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003302
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 4-1MG
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003303
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 4-1MG
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003303
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 8-2MG
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003304
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC ORAL ADMIN OF SUBOXONE 8-2MG
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003304
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$41.00
|
|
|
HC ORAL DEVICE/APPLIANCE CUSFAB
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT E0486
|
| Hospital Charge Code |
271E048601
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$600.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$600.00
|
|
|
HC ORAL DEVICE/APPLIANCE CUSFAB
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
CPT E0486
|
| Hospital Charge Code |
271E048601
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$80,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$660.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,014.81
|
| Rate for Payer: Aetna Government |
$2,014.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,818.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,818.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$808.00
|
| Rate for Payer: Amida Care Medicaid |
$808.00
|
| Rate for Payer: Brighton Health Commercial |
$900.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$960.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$816.00
|
| Rate for Payer: EmblemHealth Commercial |
$600.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$1,818.00
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$808.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$808.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,818.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,818.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$848.40
|
| Rate for Payer: Group Health Inc Commercial |
$600.00
|
| Rate for Payer: Group Health Inc Medicare |
$420.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$808.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$600.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80,800.00
|
| Rate for Payer: Healthfirst Essential Plan |
$1,818.00
|
| Rate for Payer: Healthfirst QHP |
$1,317.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$808.00
|
| Rate for Payer: SOMOS Essential |
$1,818.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,818.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$888.80
|
| Rate for Payer: United Healthcare Medicaid |
$808.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$808.00
|
|
|
HC ORAL MED, DIRECT OBSERVATION
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$41.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
|
|
HC ORAL MED, DIRECT OBSERVATION
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT H0033
|
| Hospital Charge Code |
900H003301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$65.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.40
|
| Rate for Payer: Aetna Government |
$10.40
|
| Rate for Payer: Brighton Health Commercial |
$61.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$65.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55.76
|
| Rate for Payer: EmblemHealth Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Commercial |
$41.00
|
| Rate for Payer: Group Health Inc Medicare |
$28.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$41.00
|
|
|
HC OR ENDO ADD'L 15 MINS
|
Facility
|
IP
|
$225.00
|
|
| Hospital Charge Code |
7500000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$112.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
|
|
HC OR ENDO ADD'L 15 MINS
|
Facility
|
OP
|
$225.00
|
|
| Hospital Charge Code |
7500000002
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$123.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$112.50
|
| Rate for Payer: Aetna Government |
$112.50
|
| Rate for Payer: Brighton Health Commercial |
$168.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$180.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$153.00
|
| Rate for Payer: EmblemHealth Commercial |
$112.50
|
| Rate for Payer: Group Health Inc Commercial |
$112.50
|
| Rate for Payer: Group Health Inc Medicare |
$78.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$112.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$112.50
|
|
|
HC OR ENDO FIRST HOUR
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
7500000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,237.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,125.00
|
| Rate for Payer: Aetna Government |
$1,125.00
|
| Rate for Payer: Brighton Health Commercial |
$1,687.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,800.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,530.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,125.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,125.00
|
| Rate for Payer: Group Health Inc Medicare |
$787.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,125.00
|
|
|
HC OR ENDO FIRST HOUR
|
Facility
|
IP
|
$2,250.00
|
|
| Hospital Charge Code |
7500000001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$1,125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,125.00
|
|
|
HC OR LEVEL 1 - 15 MINUTES
|
Facility
|
IP
|
$562.00
|
|
| Hospital Charge Code |
3600000001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$281.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$281.00
|
|
