|
HC POOLING OF PLATELETS/OTHER BLOOD PRODUCTS
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 86965
|
| Hospital Charge Code |
3008696501
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| 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 |
$325.50
|
| 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 |
$26.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$209.37
|
| 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 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 Commercial |
$22.57
|
| 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 |
$198.90
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC PORPHOLBILINOGEN, URINE, QUANTITATIVE
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3018411001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$18.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.44
|
| Rate for Payer: Aetna Government |
$8.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.91
|
| Rate for Payer: Brighton Health Commercial |
$15.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.07
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.44
|
| Rate for Payer: EmblemHealth Commercial |
$8.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.51
|
| Rate for Payer: Group Health Inc Commercial |
$8.44
|
| Rate for Payer: Group Health Inc Medicare |
$8.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.44
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.44
|
| Rate for Payer: Healthfirst Essential Plan |
$18.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.44
|
| Rate for Payer: Healthfirst QHP |
$8.44
|
| Rate for Payer: Humana Medicare |
$8.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare Commercial |
$10.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.44
|
| Rate for Payer: Wellcare Medicare |
$7.60
|
|
|
HC PORPHOLBILINOGEN, URINE, QUANTITATIVE
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3018411001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC PORPHYRINS, URINE, QUANTITATIVE
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3018412001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$33.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.71
|
| Rate for Payer: Aetna Government |
$14.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.30
|
| Rate for Payer: Brighton Health Commercial |
$27.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.71
|
| Rate for Payer: EmblemHealth Commercial |
$14.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.24
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$13.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$13.09
|
| Rate for Payer: Group Health Inc Commercial |
$14.71
|
| Rate for Payer: Group Health Inc Medicare |
$14.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.71
|
| Rate for Payer: Healthfirst Essential Plan |
$33.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.71
|
| Rate for Payer: Healthfirst QHP |
$14.71
|
| Rate for Payer: Humana Medicare |
$15.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare Commercial |
$18.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.71
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
|
|
HC PORPHYRINS, URINE, QUANTITATIVE
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3018412001
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.00
|
|
|
HC POST-OP FOLLOW-UP VISIT
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
5109902401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$125.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$125.00
|
|
|
HC POST-OP FOLLOW-UP VISIT
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 99024
|
| Hospital Charge Code |
5109902401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$137.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.02
|
| Rate for Payer: Aetna Government |
$9.02
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$125.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$125.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC POSTPARTUM CARE ONLY - SEPERATE PROCEDURE
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 59430
|
| Hospital Charge Code |
5145943001
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$207.50 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$207.50
|
|
|
HC POSTPARTUM CARE ONLY - SEPERATE PROCEDURE
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 59430
|
| Hospital Charge Code |
5145943001
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$167.47 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$167.47
|
| Rate for Payer: Aetna Government |
$167.47
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$207.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$207.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$213.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC POSTPARTUM CARE VISIT
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 0503F
|
| Hospital Charge Code |
9690503F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
HC POSTPARTUM CARE VISIT
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 0503F
|
| Hospital Charge Code |
9690503F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC POST-VOIDING RESIDUAL URINE CAPACITY MEASURE
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
3615179801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$123.75
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| 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 |
$14.05
|
| 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 |
$1,113.00
|
| 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 POST-VOIDING RESIDUAL URINE CAPACITY MEASURE
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 51798
|
| Hospital Charge Code |
3615179801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.50 |
| Max. Negotiated Rate |
$82.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$82.50
|
|
|
HC POTASSIUM HYDROXIDE (KOH) PREPS
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT Q0112
|
| Hospital Charge Code |
300Q011201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$11.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.83
|
| Rate for Payer: Aetna Government |
$5.83
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.08
|
| Rate for Payer: Brighton Health Commercial |
$10.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.83
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.83
|
| Rate for Payer: EmblemHealth Commercial |
$5.83
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.83
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.19
|
| Rate for Payer: Group Health Inc Commercial |
$5.83
|
| Rate for Payer: Group Health Inc Medicare |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4.96
|
| Rate for Payer: Healthfirst QHP |
$5.83
|
| Rate for Payer: Humana Medicare |
$5.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.83
|
| Rate for Payer: United Healthcare Commercial |
$5.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.83
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.54
|
| Rate for Payer: Wellcare Medicare |
$5.25
|
|
|
HC POTASSIUM HYDROXIDE (KOH) PREPS
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT Q0112
|
| Hospital Charge Code |
300Q011201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
|
|
HC PPPS, INITIAL VISIT
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT G0438
|
| Hospital Charge Code |
770G043801
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$103.18 |
| Max. Negotiated Rate |
$797.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$548.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103.18
|
| Rate for Payer: Aetna Government |
$103.18
|
| Rate for Payer: Brighton Health Commercial |
$747.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$797.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$677.96
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$498.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$498.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$184.85
|
|
|
HC PPPS, INITIAL VISIT
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT G0438
|
| Hospital Charge Code |
770G043801
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$498.50 |
| Max. Negotiated Rate |
$498.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$498.50
|
|
|
HC PPPS, SUBSEQ VISIT
|
Facility
|
IP
|
$997.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
770G043901
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$498.50 |
| Max. Negotiated Rate |
$498.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$498.50
|
|
|
HC PPPS, SUBSEQ VISIT
|
Facility
|
OP
|
$997.00
|
|
|
Service Code
|
CPT G0439
|
| Hospital Charge Code |
770G043901
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$797.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$548.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.31
|
| Rate for Payer: Aetna Government |
$70.31
|
| Rate for Payer: Brighton Health Commercial |
$747.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$797.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$677.96
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$498.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$498.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.38
|
|
|
HC PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
6369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$4,368.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$125.92
|
| Rate for Payer: Aetna Government |
$125.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$98.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$98.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$43.68
|
| Rate for Payer: Amida Care Medicaid |
$43.68
|
| Rate for Payer: Brighton Health Commercial |
$124.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.60
|
| Rate for Payer: EmblemHealth Commercial |
$104.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$98.28
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$43.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$43.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$98.28
|
| Rate for Payer: Fidelis Essential Plan QHP |
$98.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.86
|
| Rate for Payer: Group Health Inc Commercial |
$104.00
|
| Rate for Payer: Group Health Inc Medicare |
$72.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4,368.00
|
| Rate for Payer: Healthfirst Essential Plan |
$98.28
|
| Rate for Payer: Healthfirst QHP |
$71.20
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$43.68
|
| Rate for Payer: SOMOS Essential |
$98.28
|
| Rate for Payer: United Healthcare Commercial |
$133.47
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$98.28
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48.05
|
| Rate for Payer: United Healthcare Medicaid |
$43.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.20
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.68
|
|
|
HC PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
6369073201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.00
|
|
|
HC PRENATAL FLOW SHEET
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 0501F
|
| Hospital Charge Code |
9690501F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$5.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
|
|
HC PRENATAL FLOW SHEET
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 0501F
|
| Hospital Charge Code |
9690501F01
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: EmblemHealth Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
HC PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4609464001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$459.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$315.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$248.51
|
| Rate for Payer: Aetna Government |
$248.51
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$173.96
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$173.96
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$173.96
|
| Rate for Payer: Brighton Health Commercial |
$430.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$248.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$459.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$390.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$248.51
|
| Rate for Payer: EmblemHealth Commercial |
$248.51
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$223.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$211.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$221.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$248.51
|
| Rate for Payer: Fidelis Qualified Health Plan |
$221.17
|
| Rate for Payer: Group Health Inc Commercial |
$248.51
|
| Rate for Payer: Group Health Inc Medicare |
$248.51
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$248.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$248.51
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.23
|
| Rate for Payer: Healthfirst QHP |
$248.51
|
| Rate for Payer: Humana Medicare |
$253.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.51
|
| Rate for Payer: United Healthcare Commercial |
$287.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$248.51
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$236.08
|
| Rate for Payer: Wellcare Medicare |
$236.08
|
|
|
HC PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4609464001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$287.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$287.00
|
|
