|
HC REPOSITN PREV IMPLNT ICD ELECTRODE
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
3613321501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC REPTILASE TEST - REPTILASE TIME
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
3058563501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$15.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.50
|
|
|
HC REPTILASE TEST - REPTILASE TIME
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85635
|
| Hospital Charge Code |
3058563501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.85
|
| Rate for Payer: Aetna Government |
$9.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.89
|
| Rate for Payer: Brighton Health Commercial |
$23.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$9.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$9.85
|
| Rate for Payer: EmblemHealth Commercial |
$9.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$8.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$9.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8.77
|
| Rate for Payer: Group Health Inc Commercial |
$9.85
|
| Rate for Payer: Group Health Inc Medicare |
$9.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.56
|
| Rate for Payer: Healthfirst Essential Plan |
$19.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9.85
|
| Rate for Payer: Healthfirst QHP |
$9.85
|
| Rate for Payer: Humana Medicare |
$10.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$9.85
|
| Rate for Payer: United Healthcare Commercial |
$12.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.56
|
| Rate for Payer: Wellcare Medicare |
$8.87
|
|
|
HC RESEC TOE AT I-P JT, SINGLE, EACH
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
3612816001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.31 |
| Max. Negotiated Rate |
$6,218.25 |
| 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 |
$6,218.25
|
| 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 |
$1,579.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$309.31
|
| 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 RESEC TOE AT I-P JT, SINGLE, EACH
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 28160
|
| Hospital Charge Code |
3612816001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,145.50 |
| Max. Negotiated Rate |
$4,145.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.50
|
|
|
HC RESPIRATORY FLOW VOLUME LOOP - FLOW VOLUME LOOP
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
4609437501
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC RESPIRATORY FLOW VOLUME LOOP - FLOW VOLUME LOOP
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
4609437501
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$421.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$266.33
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$266.33
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$266.33
|
| Rate for Payer: Brighton Health Commercial |
$574.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$380.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$612.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$520.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$380.47
|
| Rate for Payer: EmblemHealth Commercial |
$380.47
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$342.42
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$323.40
|
| Rate for Payer: Fidelis Essential Plan QHP |
$338.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$380.47
|
| Rate for Payer: Fidelis Qualified Health Plan |
$338.62
|
| 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 |
$380.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$380.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$323.40
|
| Rate for Payer: Healthfirst QHP |
$380.47
|
| Rate for Payer: Humana Medicare |
$388.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$380.47
|
| Rate for Payer: United Healthcare Commercial |
$383.00
|
| 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 |
$361.45
|
| Rate for Payer: Wellcare Medicare |
$361.45
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS VACCINE, PREF, SUBUNIT, BIVALENT, FOR INTRAMUSCULAR USE
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6369067801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$401.00 |
| Max. Negotiated Rate |
$401.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.00
|
|
|
HC RESPIRATORY SYNCYTIAL VIRUS VACCINE, PREF, SUBUNIT, BIVALENT, FOR INTRAMUSCULAR USE
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 90678
|
| Hospital Charge Code |
6369067801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.70 |
| Max. Negotiated Rate |
$521.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$441.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$401.00
|
| Rate for Payer: Aetna Government |
$401.00
|
| Rate for Payer: Brighton Health Commercial |
$481.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$401.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$461.15
|
| Rate for Payer: EmblemHealth Commercial |
$401.00
|
| Rate for Payer: Group Health Inc Commercial |
$401.00
|
| Rate for Payer: Group Health Inc Medicare |
$280.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$401.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$401.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$521.30
|
|
|
HC RESP SYNCYTIAL AG, DFA - RESP SYNCYTIAL VIRUS DFA
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
3068728001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.42
|
| Rate for Payer: Aetna Government |
$13.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.39
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.39
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.39
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.42
|
| Rate for Payer: EmblemHealth Commercial |
$13.42
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.41
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.94
|
| Rate for Payer: Group Health Inc Commercial |
$13.42
|
| Rate for Payer: Group Health Inc Medicare |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.42
|
| Rate for Payer: Healthfirst QHP |
$13.42
|
| Rate for Payer: Humana Medicare |
$13.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$12.08
|
|
|
HC RESP SYNCYTIAL AG, DFA - RESP SYNCYTIAL VIRUS DFA
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
3068728001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC RESUPERF WND FACE <2.5 CM
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
3611201102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC RESUPERF WND FACE <2.5 CM
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
3611201102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
3058504501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$7.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.99
|
| Rate for Payer: Aetna Government |
$3.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2.79
|
| Rate for Payer: Brighton Health Commercial |
$3.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$3.99
|
| Rate for Payer: EmblemHealth Commercial |
$3.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3.59
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3.39
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$3.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3.55
|
| Rate for Payer: Group Health Inc Commercial |
$3.99
|
| Rate for Payer: Group Health Inc Medicare |
$3.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Healthfirst Essential Plan |
$7.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3.99
|
| Rate for Payer: Healthfirst QHP |
$3.99
|
| Rate for Payer: Humana Medicare |
$4.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3.99
|
| Rate for Payer: United Healthcare Commercial |
$5.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.20
|
| Rate for Payer: Wellcare Medicare |
$3.59
|
|
|
HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
3058504501
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
|
|
HC RETREVIAL IVC FILTER, ENDOVASCULAR APPROACH
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3613719301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$386.28 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,845.68
|
| Rate for Payer: Aetna Government |
$3,845.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,691.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,691.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,691.98
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,845.68
|
| 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 |
$3,845.68
|
| Rate for Payer: EmblemHealth Commercial |
$3,845.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,461.11
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,268.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,422.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,845.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,422.66
|
| Rate for Payer: Group Health Inc Commercial |
$3,845.68
|
| Rate for Payer: Group Health Inc Medicare |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,845.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,588.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$386.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,268.83
|
| Rate for Payer: Healthfirst QHP |
$3,845.68
|
| Rate for Payer: Humana Medicare |
$3,922.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,845.68
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,845.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,845.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,653.40
|
| Rate for Payer: Wellcare Medicare |
$3,653.40
|
|
|
HC RETREVIAL IVC FILTER, ENDOVASCULAR APPROACH
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3613719301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC RETROBULBAR INJECTION EYE SOCKET
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
5106750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC RETROBULBAR INJECTION EYE SOCKET
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
5106750001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.99 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| 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 |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC RETROGRADE RETHROCYSTOGRAPHY
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
3615161001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.14
|
| Rate for Payer: Aetna Government |
$78.14
|
| Rate for Payer: Brighton Health Commercial |
$641.25
|
| 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: EmblemHealth Commercial |
$427.50
|
| Rate for Payer: Group Health Inc Commercial |
$427.50
|
| Rate for Payer: Group Health Inc Medicare |
$299.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$427.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.10
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC RETROGRADE RETHROCYSTOGRAPHY
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
3615161001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$427.50 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$427.50
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY
|
Facility
|
IP
|
$15,004.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
3613722401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,502.00 |
| Max. Negotiated Rate |
$7,502.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.00
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY
|
Facility
|
OP
|
$15,004.00
|
|
|
Service Code
|
CPT 37224
|
| Hospital Charge Code |
3613722401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$510.38 |
| Max. Negotiated Rate |
$11,253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,966.23
|
| Rate for Payer: Aetna Government |
$6,966.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,876.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,876.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,876.36
|
| Rate for Payer: Brighton Health Commercial |
$11,253.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,966.23
|
| 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 |
$6,966.23
|
| Rate for Payer: EmblemHealth Commercial |
$6,966.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,269.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,921.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,199.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,966.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,199.94
|
| Rate for Payer: Group Health Inc Commercial |
$6,966.23
|
| Rate for Payer: Group Health Inc Medicare |
$6,966.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,966.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,639.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$510.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,921.30
|
| Rate for Payer: Healthfirst QHP |
$6,966.23
|
| Rate for Payer: Humana Medicare |
$7,105.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,966.23
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,966.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,966.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,617.92
|
| Rate for Payer: Wellcare Medicare |
$6,617.92
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY, W/ ARTHERECTOMY
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 37225 TC
|
| Hospital Charge Code |
3613722501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY, W/ ARTHERECTOMY
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 37225 TC
|
| Hospital Charge Code |
3613722501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,628.64 |
| Max. Negotiated Rate |
$22,507.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11,956.91
|
| Rate for Payer: Aetna Government |
$11,956.91
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| 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: EmblemHealth Commercial |
$15,005.00
|
| Rate for Payer: Group Health Inc Commercial |
$15,005.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,444.93
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
