|
HC PARTIAL REMOVAL OF TOE, PHALANX
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
3612812401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$285.94 |
| Max. Negotiated Rate |
$6,695.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,964.33
|
| Rate for Payer: Aetna Government |
$3,964.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,775.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,775.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,775.03
|
| Rate for Payer: Brighton Health Commercial |
$6,695.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,964.33
|
| 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 |
$3,964.33
|
| Rate for Payer: EmblemHealth Commercial |
$3,964.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,567.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,369.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,528.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,964.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,528.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,964.33
|
| Rate for Payer: Group Health Inc Medicare |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$285.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$387.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,369.68
|
| Rate for Payer: Healthfirst QHP |
$3,964.33
|
| Rate for Payer: Humana Medicare |
$4,043.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,964.33
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,964.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,964.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,766.11
|
| Rate for Payer: Wellcare Medicare |
$3,766.11
|
|
|
HC PARTICLE AGGLUTINATION TEST, SCREEN - BACTERIAL ANTIGEN DETECTION
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3028640301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC PARTICLE AGGLUTINATION TEST, SCREEN - BACTERIAL ANTIGEN DETECTION
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3028640301
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.54
|
| Rate for Payer: Aetna Government |
$11.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.08
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.54
|
| Rate for Payer: EmblemHealth Commercial |
$11.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Group Health Inc Commercial |
$11.54
|
| Rate for Payer: Group Health Inc Medicare |
$11.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Healthfirst Essential Plan |
$8.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.54
|
| Rate for Payer: Healthfirst QHP |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$12.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Wellcare Medicare |
$10.39
|
|
|
HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCAL ANTIGEN
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3028640302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.54
|
| Rate for Payer: Aetna Government |
$11.54
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.08
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.54
|
| Rate for Payer: EmblemHealth Commercial |
$11.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Group Health Inc Commercial |
$11.54
|
| Rate for Payer: Group Health Inc Medicare |
$11.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Healthfirst Essential Plan |
$8.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.54
|
| Rate for Payer: Healthfirst QHP |
$11.54
|
| Rate for Payer: Humana Medicare |
$11.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare Commercial |
$12.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Wellcare Medicare |
$10.39
|
|
|
HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCAL ANTIGEN
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3028640302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC PARTICLE AGGLUTINATION TEST, TITER - CRYPTOCOCCUS ANTIGEN TITER
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
3028640602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
|
|
HC PARTICLE AGGLUTINATION TEST, TITER - CRYPTOCOCCUS ANTIGEN TITER
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
3028640602
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.64
|
| Rate for Payer: Aetna Government |
$10.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.45
|
| Rate for Payer: Brighton Health Commercial |
$19.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.64
|
| Rate for Payer: EmblemHealth Commercial |
$10.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.47
|
| Rate for Payer: Group Health Inc Commercial |
$10.64
|
| Rate for Payer: Group Health Inc Medicare |
$10.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.64
|
| Rate for Payer: Healthfirst QHP |
$10.64
|
| Rate for Payer: Humana Medicare |
$10.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.64
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.11
|
| Rate for Payer: Wellcare Medicare |
$9.58
|
|
|
HC PART SIMPLE REMV VULVA
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
3615662001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.92 |
| Max. Negotiated Rate |
$6,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$684.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC PART SIMPLE REMV VULVA
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 56620
|
| Hospital Charge Code |
3615662001
|
|
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 PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3028674703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3028674703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.03
|
| Rate for Payer: Aetna Government |
$15.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.52
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.03
|
| Rate for Payer: EmblemHealth Commercial |
$15.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.38
|
| Rate for Payer: Group Health Inc Commercial |
$15.03
|
| Rate for Payer: Group Health Inc Medicare |
$15.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Healthfirst Essential Plan |
$33.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.03
|
| Rate for Payer: Healthfirst QHP |
$15.03
|
| Rate for Payer: Humana Medicare |
$15.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$19.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
|
|
HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3028674701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.03
|
| Rate for Payer: Aetna Government |
$15.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.52
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.03
|
| Rate for Payer: EmblemHealth Commercial |
$15.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.38
|
| Rate for Payer: Group Health Inc Commercial |
$15.03
|
| Rate for Payer: Group Health Inc Medicare |
$15.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Healthfirst Essential Plan |
$33.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.03
|
| Rate for Payer: Healthfirst QHP |
$15.03
|
| Rate for Payer: Humana Medicare |
$15.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$19.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
|
|
HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGG AND IGM
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3028674701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGM
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3028674702
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC PARVOVIRUS - PARVOVIRUS B19 ANTIBODY, IGM
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
3028674702
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.03
|
| Rate for Payer: Aetna Government |
$15.03
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.52
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.52
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.52
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$15.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.50
|
| Rate for Payer: Elderplan Medicare Advantage |
$15.03
|
| Rate for Payer: EmblemHealth Commercial |
$15.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$15.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.38
|
| Rate for Payer: Group Health Inc Commercial |
$15.03
|
| Rate for Payer: Group Health Inc Medicare |
$15.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Healthfirst Essential Plan |
$33.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15.03
|
| Rate for Payer: Healthfirst QHP |
$15.03
|
| Rate for Payer: Humana Medicare |
$15.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$19.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$15.03
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
|
|
HC PATH CLIN CONSLT HIGH 41-60
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 80505
|
| Hospital Charge Code |
3108050501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.51 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$252.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$209.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$367.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$312.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$97.69
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.51
|
| Rate for Payer: Healthfirst Essential Plan |
$131.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$58.51
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC PATH CLIN CONSLT HIGH 41-60
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 80505
|
| Hospital Charge Code |
3108050501
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.50
|
|
|
HC PATH CLIN CONSLT MOD 21-40
|
Facility
|
IP
|
$459.00
|
|
|
Service Code
|
CPT 80504
|
| Hospital Charge Code |
3108050401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$229.50
|
|
|
HC PATH CLIN CONSLT MOD 21-40
|
Facility
|
OP
|
$459.00
|
|
|
Service Code
|
CPT 80504
|
| Hospital Charge Code |
3108050401
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.29 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$252.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$209.37
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$367.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$312.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$50.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.29
|
| Rate for Payer: Healthfirst Essential Plan |
$72.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.29
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC PATH CLIN CONSLT STRTFWD
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 80503
|
| Hospital Charge Code |
3108050301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.28
|
| Rate for Payer: Aetna Government |
$65.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.70
|
| Rate for Payer: Brighton Health Commercial |
$65.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$121.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$103.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.28
|
| Rate for Payer: EmblemHealth Commercial |
$23.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.10
|
| Rate for Payer: Group Health Inc Commercial |
$65.28
|
| Rate for Payer: Group Health Inc Medicare |
$65.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.15
|
| Rate for Payer: Healthfirst Essential Plan |
$36.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.28
|
| Rate for Payer: Healthfirst QHP |
$65.28
|
| Rate for Payer: Humana Medicare |
$66.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.15
|
| Rate for Payer: Wellcare Medicare |
$58.75
|
|
|
HC PATH CLIN CONSLT STRTFWD
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 80503
|
| Hospital Charge Code |
3108050301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.00
|
|
|
HC PATH CONSULT DURING SURGERY
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 88329 TC
|
| Hospital Charge Code |
3128832901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$31.54 |
| Max. Negotiated Rate |
$75.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.54
|
| Rate for Payer: Aetna Government |
$31.54
|
| Rate for Payer: Brighton Health Commercial |
$75.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.89
|
| Rate for Payer: EmblemHealth Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Commercial |
$50.50
|
| Rate for Payer: Group Health Inc Medicare |
$35.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.50
|
|
|
HC PATH CONSULT DURING SURGERY
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 88329 TC
|
| Hospital Charge Code |
3128832901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$50.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.50
|
|
|
HC PATH CONSULT IN SURG,W ADDN FRZ SEC - BLOCK
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 88332 TC
|
| Hospital Charge Code |
3128833201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.50
|
|
|
HC PATH CONSULT IN SURG,W ADDN FRZ SEC - BLOCK
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 88332 TC
|
| Hospital Charge Code |
3128833201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$11.41 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.20
|
| Rate for Payer: Aetna Government |
$12.20
|
| Rate for Payer: Brighton Health Commercial |
$60.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.41
|
| Rate for Payer: EmblemHealth Commercial |
$29.34
|
| Rate for Payer: Group Health Inc Commercial |
$40.50
|
| Rate for Payer: Group Health Inc Medicare |
$28.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.34
|
|
