|
HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
3028643001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.14
|
| Rate for Payer: Aetna Government |
$6.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.30
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.14
|
| Rate for Payer: EmblemHealth Commercial |
$6.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.46
|
| Rate for Payer: Group Health Inc Commercial |
$6.14
|
| Rate for Payer: Group Health Inc Medicare |
$6.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.93
|
| Rate for Payer: Healthfirst Essential Plan |
$11.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.14
|
| Rate for Payer: Healthfirst QHP |
$6.14
|
| Rate for Payer: Humana Medicare |
$6.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.14
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.93
|
| Rate for Payer: Wellcare Medicare |
$5.53
|
|
|
HC RH IG FULL DOSE IM
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
6369038401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$235.00 |
| Max. Negotiated Rate |
$235.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
|
|
HC RH IG FULL DOSE IM
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
6369038401
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$258.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$77.03
|
| Rate for Payer: Aetna Government |
$77.03
|
| Rate for Payer: Brighton Health Commercial |
$282.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$235.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$270.25
|
| Rate for Payer: EmblemHealth Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Commercial |
$235.00
|
| Rate for Payer: Group Health Inc Medicare |
$164.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$235.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$235.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$305.50
|
|
|
HC RHIGV HUMAN ONLY FOR IV USE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 90386
|
| Hospital Charge Code |
6369038601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.91
|
| Rate for Payer: Aetna Government |
$9.91
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.25
|
| Rate for Payer: EmblemHealth Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.50
|
|
|
HC RHIGV HUMAN ONLY FOR IV USE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 90386
|
| Hospital Charge Code |
6369038601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$15.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
HC RHYTHM ECG - REPORT ONLY
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 93042
|
| Hospital Charge Code |
9859304201
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
|
|
HC RHYTHM ECG - REPORT ONLY
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 93042
|
| Hospital Charge Code |
9859304201
|
|
Hospital Revenue Code
|
985
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$39.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.05
|
| Rate for Payer: Aetna Government |
$6.05
|
| Rate for Payer: Brighton Health Commercial |
$36.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.32
|
| Rate for Payer: EmblemHealth Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$17.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.34
|
|
|
HC RHYTHM ECG W/REPORT
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
7309304001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.29
|
| Rate for Payer: Aetna Government |
$11.29
|
| Rate for Payer: Brighton Health Commercial |
$35.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.96
|
| Rate for Payer: EmblemHealth Commercial |
$23.50
|
| Rate for Payer: Group Health Inc Commercial |
$23.50
|
| Rate for Payer: Group Health Inc Medicare |
$16.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.33
|
| Rate for Payer: United Healthcare Commercial |
$101.00
|
|
|
HC RHYTHM ECG W/REPORT
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
7309304001
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.50
|
|
|
HC RIA NONANTIBODY - ACHR BINDING ABS, SERUM
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3018351901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC RIA NONANTIBODY - ACHR BINDING ABS, SERUM
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3018351901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.40
|
| Rate for Payer: Aetna Government |
$18.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.88
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.40
|
| Rate for Payer: EmblemHealth Commercial |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.38
|
| Rate for Payer: Group Health Inc Commercial |
$18.40
|
| Rate for Payer: Group Health Inc Medicare |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.40
|
| Rate for Payer: Healthfirst QHP |
$18.40
|
| Rate for Payer: Humana Medicare |
$18.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$17.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.48
|
| Rate for Payer: Wellcare Medicare |
$16.56
|
|
|
HC RIA NONANTIBODY - IGF-2
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3018351902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$25.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.40
|
| Rate for Payer: Aetna Government |
$18.40
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$12.88
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$12.88
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$12.88
|
| Rate for Payer: Brighton Health Commercial |
$34.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$18.40
|
| Rate for Payer: EmblemHealth Commercial |
$18.40
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$16.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$15.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$16.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$18.40
|
| Rate for Payer: Fidelis Qualified Health Plan |
$16.38
|
| Rate for Payer: Group Health Inc Commercial |
$18.40
|
| Rate for Payer: Group Health Inc Medicare |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.40
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18.40
|
| Rate for Payer: Healthfirst QHP |
$18.40
|
| Rate for Payer: Humana Medicare |
$18.77
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare Commercial |
$17.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.40
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17.48
|
| Rate for Payer: Wellcare Medicare |
$16.56
|
|
|
HC RIA NONANTIBODY - IGF-2
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
3018351902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.00
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY, IGG
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
3028675703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$43.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Healthfirst Essential Plan |
$43.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$17.41
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY, IGG
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
3028675703
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY, IGG/IGM
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
3028675701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$43.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Healthfirst Essential Plan |
$43.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$17.41
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY, IGG/IGM
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
3028675701
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY, IGM
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
3028675702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.00
|
|
|
HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY, IGM
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
3028675702
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$43.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.35
|
| Rate for Payer: Aetna Government |
$19.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$13.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$13.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.54
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$19.35
|
| Rate for Payer: EmblemHealth Commercial |
$19.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$16.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$17.22
|
| Rate for Payer: Fidelis Medicare Advantage |
$19.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$17.22
|
| Rate for Payer: Group Health Inc Commercial |
$19.35
|
| Rate for Payer: Group Health Inc Medicare |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Healthfirst Essential Plan |
$43.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19.35
|
| Rate for Payer: Healthfirst QHP |
$19.35
|
| Rate for Payer: Humana Medicare |
$19.74
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare Commercial |
$24.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.35
|
| Rate for Payer: Wellcare Medicare |
$17.41
|
|
|
HC RMVL FOREIGN BODY, UPPER ARM/ELBOW, SUBCUT
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
3612420001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.15 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$148.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC RMVL FOREIGN BODY, UPPER ARM/ELBOW, SUBCUT
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
3612420001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC RMVL OF F/B FROM DEEP PENILE TISSUE
|
Facility
|
OP
|
$7,023.00
|
|
|
Service Code
|
CPT 54115 TC
|
| Hospital Charge Code |
3615411501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.20 |
| Max. Negotiated Rate |
$5,267.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$532.20
|
| Rate for Payer: Aetna Government |
$532.20
|
| Rate for Payer: Brighton Health Commercial |
$5,267.25
|
| 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 |
$3,511.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,511.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,458.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.90
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC RMVL OF F/B FROM DEEP PENILE TISSUE
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 54115 TC
|
| Hospital Charge Code |
3615411501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,511.50 |
| Max. Negotiated Rate |
$3,511.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.50
|
|
|
HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 50387 TC
|
| Hospital Charge Code |
3615038701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 50387 TC
|
| Hospital Charge Code |
3615038701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$669.70 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.70
|
| Rate for Payer: Aetna Government |
$669.70
|
| Rate for Payer: Brighton Health Commercial |
$4,023.75
|
| 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 |
$2,682.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,682.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,877.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
|
