|
HC PSYCL/NRPSYC TST PHY/QHP ADD'L HR
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
9189613701
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$239.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.40
|
| Rate for Payer: Aetna Government |
$16.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.41
|
| Rate for Payer: Amida Care Medicaid |
$106.41
|
| Rate for Payer: Brighton Health Commercial |
$156.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$106.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.12
|
| Rate for Payer: EmblemHealth Commercial |
$104.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$239.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$106.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.73
|
| Rate for Payer: Group Health Inc Commercial |
$104.50
|
| Rate for Payer: Group Health Inc Medicare |
$73.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.41
|
| Rate for Payer: Healthfirst Essential Plan |
$239.43
|
| Rate for Payer: Healthfirst QHP |
$173.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.43
|
| Rate for Payer: Optum Medicaid |
$0.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: SOMOS Essential |
$239.43
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$239.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$117.05
|
| Rate for Payer: United Healthcare Medicaid |
$106.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.41
|
|
|
HC PSYCL/NRPSYC TST TECH ADD'L HR
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
9189613901
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$239.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.02
|
| Rate for Payer: Aetna Government |
$35.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.41
|
| Rate for Payer: Amida Care Medicaid |
$106.41
|
| Rate for Payer: Brighton Health Commercial |
$156.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$106.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$167.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$142.12
|
| Rate for Payer: EmblemHealth Commercial |
$104.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$239.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$106.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.73
|
| Rate for Payer: Group Health Inc Commercial |
$104.50
|
| Rate for Payer: Group Health Inc Medicare |
$73.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$106.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.41
|
| Rate for Payer: Healthfirst Essential Plan |
$239.43
|
| Rate for Payer: Healthfirst QHP |
$173.45
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.43
|
| Rate for Payer: Optum Medicaid |
$0.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: SOMOS Essential |
$239.43
|
| Rate for Payer: United Healthcare Commercial |
$104.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$239.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$117.05
|
| Rate for Payer: United Healthcare Medicaid |
$106.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.41
|
|
|
HC PSYCL/NRPSYC TST TECH ADD'L HR
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
9189613901
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$104.50 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.50
|
|
|
HC PSYCL TST EVAL PHYS/QHP 1ST HR
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
9189613001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC PSYCL TST EVAL PHYS/QHP 1ST HR
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
9189613001
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$388.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$239.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$239.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$106.41
|
| Rate for Payer: Amida Care Medicaid |
$106.41
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$106.41
|
| 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 |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$239.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$106.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$239.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$239.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$111.73
|
| 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 |
$106.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.41
|
| Rate for Payer: Healthfirst Essential Plan |
$239.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$173.45
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$106.41
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$239.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$239.43
|
| Rate for Payer: Optum Medicaid |
$0.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$106.41
|
| Rate for Payer: SOMOS Essential |
$239.43
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$239.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$117.05
|
| Rate for Payer: United Healthcare Medicaid |
$106.41
|
| 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 |
$106.41
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC PSYCL TST EVAL PHYS/QHP ADD'L HR
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
9189613101
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC PSYCL TST EVAL PHYS/QHP ADD'L HR
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
9189613101
|
|
Hospital Revenue Code
|
918
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$70.24
|
| Rate for Payer: Aetna Government |
$70.24
|
| 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 |
$79.31
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
|
|
HC PT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN
|
Facility
|
IP
|
$95.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
4209753701
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$47.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.50
|
|
|
HC PT COMMUNITY/WORK REINTEGRATION TRAINJ EA 15 MIN
|
Facility
|
OP
|
$95.00
|
|
|
Service Code
|
CPT 97537 GP
|
| Hospital Charge Code |
4209753701
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$18.08 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.08
|
| Rate for Payer: Aetna Government |
$18.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$125.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$125.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$55.87
|
| Rate for Payer: Amida Care Medicaid |
$55.87
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$47.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$125.70
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$55.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$125.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$125.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.66
|
| Rate for Payer: Group Health Inc Commercial |
$47.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$55.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Healthfirst Essential Plan |
$125.70
|
| Rate for Payer: Healthfirst QHP |
$91.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$55.87
|
| Rate for Payer: SOMOS Essential |
$125.70
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$125.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61.45
|
| Rate for Payer: United Healthcare Medicaid |
$55.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$55.87
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT CONTRAST BATH THERAPY
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
4209703401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.00
|
|
|
HC PT CONTRAST BATH THERAPY
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 97034 GP
|
| Hospital Charge Code |
4209703401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.95
|
| Rate for Payer: Aetna Government |
$10.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$22.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$22.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
4209759701
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$290.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66.09
|
| Rate for Payer: Aetna Government |
$66.09
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$264.50
|
| Rate for Payer: Group Health Inc Commercial |
$264.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT DEBRIDEMENT OPEN WOUND 20 SQ CM<
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
4209759701
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
4209759801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.33 |
| Max. Negotiated Rate |
$290.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.33
|
| Rate for Payer: Aetna Government |
$21.33
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$264.50
|
| Rate for Payer: Group Health Inc Commercial |
$264.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$264.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT DEBRIDEMENT OPEN WOUND EA ADDL 20 SQ CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
4209759801
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC PT DIATHERMY TREATMENT
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 97024 GP
|
| Hospital Charge Code |
4209702401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.50
|
|
|
HC PT DIATHERMY TREATMENT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 97024 GP
|
| Hospital Charge Code |
4209702401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.97
|
| Rate for Payer: Aetna Government |
$3.97
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$10.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$10.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT ELECTRICAL STIMULATION
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
4209703201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC PT ELECTRICAL STIMULATION
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
4209703201
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$21.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT ELECTRIC CURRENT THERAPY
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
4209703301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.94
|
| Rate for Payer: Aetna Government |
$15.94
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$30.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$30.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT ELECTRIC CURRENT THERAPY
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
4209703301
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
|
|
HC PT ELECTRIC STIMULATION THERAPY
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 97014 GP
|
| Hospital Charge Code |
4209701401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.69
|
| Rate for Payer: Aetna Government |
$9.69
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$71.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$71.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.91
|
| Rate for Payer: Amida Care Medicaid |
$31.91
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$16.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$71.81
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$31.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$71.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$71.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33.51
|
| Rate for Payer: Group Health Inc Commercial |
$16.00
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Healthfirst Essential Plan |
$71.81
|
| Rate for Payer: Healthfirst QHP |
$52.02
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$31.91
|
| Rate for Payer: SOMOS Essential |
$71.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$71.81
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.11
|
| Rate for Payer: United Healthcare Medicaid |
$31.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.91
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC PT ELECTRIC STIMULATION THERAPY
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
CPT 97014 GP
|
| Hospital Charge Code |
4209701401
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.00
|
|
|
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
3108132301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$64.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$300.00
|
| Rate for Payer: Aetna Government |
$300.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$210.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$210.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$210.00
|
| Rate for Payer: Brighton Health Commercial |
$300.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$300.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$93.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$79.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$300.00
|
| Rate for Payer: EmblemHealth Commercial |
$300.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$270.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$255.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$267.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$300.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$267.00
|
| Rate for Payer: Group Health Inc Commercial |
$300.00
|
| Rate for Payer: Group Health Inc Medicare |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$300.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$300.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$300.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$300.00
|
| Rate for Payer: Healthfirst QHP |
$300.00
|
| Rate for Payer: Humana Medicare |
$306.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$300.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$300.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$285.00
|
| Rate for Payer: Wellcare Medicare |
$270.00
|
|
|
HC PTEN GENE ANALYSIS DUPLICATION/DELETION VARIANT
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 81323
|
| Hospital Charge Code |
3108132301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$58.50
|
|
