|
HC RSV MONOC ANTB SEASN .5ML IM
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
6369038001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$47.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.00
|
|
|
HC RSV VACC PREF RECOMB ADJT IM
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
7719067901
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.50
|
| Rate for Payer: Aetna Government |
$54.50
|
| Rate for Payer: Brighton Health Commercial |
$81.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$87.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$74.12
|
| 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 |
$54.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.50
|
| Rate for Payer: United Healthcare Commercial |
$44.00
|
|
|
HC RSV VACC PREF RECOMB ADJT IM
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
7719067901
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$54.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.50
|
|
|
HC RT BIOFEEDBACK TRAINING,ANY MODALITY
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 90901 GP
|
| Hospital Charge Code |
4209090101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.30
|
| Rate for Payer: Aetna Government |
$96.30
|
| 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 |
$28.50
|
| Rate for Payer: Group Health Inc Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC RT BIOFEEDBACK TRAINING,ANY MODALITY
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 90901 GP
|
| Hospital Charge Code |
4209090101
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC RT BIOFEEDBACK TRAINING,ANY MODALITY
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 90901 GO
|
| Hospital Charge Code |
4309090101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.30
|
| Rate for Payer: Aetna Government |
$96.30
|
| 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 |
$28.50
|
| Rate for Payer: Group Health Inc Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.50
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC RT BIOFEEDBACK TRAINING,ANY MODALITY
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 90901 GO
|
| Hospital Charge Code |
4309090101
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.50 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
|
|
HC RT BIPAP NON-EMERGENT
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$278.50 |
| Max. Negotiated Rate |
$278.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.50
|
|
|
HC RT BIPAP NON-EMERGENT
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466006
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$417.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.35
|
| 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 |
$417.75
|
| 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 |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| 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 |
$40.14
|
| 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 |
$278.50
|
| 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 RT BIPAP NON-EMERGENT SUBSEQ DAY
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$278.50 |
| Max. Negotiated Rate |
$278.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.50
|
|
|
HC RT BIPAP NON-EMERGENT SUBSEQ DAY
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466007
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$40.14 |
| Max. Negotiated Rate |
$417.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.35
|
| 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 |
$417.75
|
| 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 |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| 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 |
$40.14
|
| 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 |
$278.50
|
| 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 RT BREATHING CAPACITY TEST
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4109401001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$31.55 |
| Max. Negotiated Rate |
$314.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$31.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$209.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC RT BREATHING CAPACITY TEST
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 94010
|
| Hospital Charge Code |
4109401001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC RT CHEST WALL MANIPULATION, INITIAL
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4109466701
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC RT CHEST WALL MANIPULATION, INITIAL
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4109466701
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$165.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC RT CHEST WALL MANIPULATION,SUBSEQUENT
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4109466801
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.00
|
|
|
HC RT CHEST WALL MANIPULATION,SUBSEQUENT
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4109466801
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$297.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC RT CONTINUOUS INHALATION TX, 1ST HR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4109464401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC RT CONTINUOUS INHALATION TX, 1ST HR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 94644
|
| Hospital Charge Code |
4109464401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$93.38 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$181.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$210.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$210.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$93.38
|
| Rate for Payer: Amida Care Medicaid |
$93.38
|
| Rate for Payer: Brighton Health Commercial |
$247.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$210.11
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$93.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.05
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.38
|
| Rate for Payer: Healthfirst Essential Plan |
$210.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$152.21
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.38
|
| Rate for Payer: SOMOS Essential |
$210.11
|
| Rate for Payer: United Healthcare Commercial |
$165.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$210.11
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$102.72
|
| Rate for Payer: United Healthcare Medicaid |
$93.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$93.38
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC RT CONTINUOUS INHALATION TX, EACH ADD HR
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
4109464501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$210.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$210.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$210.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$93.38
|
| Rate for Payer: Amida Care Medicaid |
$93.38
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: EmblemHealth Commercial |
$21.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$210.11
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$93.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$93.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$210.11
|
| Rate for Payer: Fidelis Qualified Health Plan |
$98.05
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$93.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$93.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.38
|
| Rate for Payer: Healthfirst Essential Plan |
$210.11
|
| Rate for Payer: Healthfirst QHP |
$152.21
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$93.38
|
| Rate for Payer: SOMOS Essential |
$210.11
|
| Rate for Payer: United Healthcare Commercial |
$21.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$210.11
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$102.72
|
| Rate for Payer: United Healthcare Medicaid |
$93.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$93.38
|
|
|
HC RT CONTINUOUS INHALATION TX, EACH ADD HR
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
4109464501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC RT CPT SUBSEQUENT
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4109466802
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$297.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$45.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC RT CPT SUBSEQUENT
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4109466802
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$198.00
|
|
|
HC RT DELIVERY/BIRTHING ROOM RESUSCITATION
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
4109946501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$140.51 |
| Max. Negotiated Rate |
$1,322.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$969.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$799.53
|
| Rate for Payer: Aetna Government |
$799.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$559.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$559.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$559.67
|
| Rate for Payer: Brighton Health Commercial |
$1,322.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$799.53
|
| Rate for Payer: EmblemHealth Commercial |
$799.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$719.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.58
|
| Rate for Payer: Group Health Inc Commercial |
$799.53
|
| Rate for Payer: Group Health Inc Medicare |
$799.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$799.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$154.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.60
|
| Rate for Payer: Healthfirst QHP |
$799.53
|
| Rate for Payer: Humana Medicare |
$815.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.53
|
| Rate for Payer: United Healthcare Commercial |
$881.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$799.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$759.55
|
| Rate for Payer: Wellcare Medicare |
$759.55
|
|
|
HC RT DELIVERY/BIRTHING ROOM RESUSCITATION
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
4109946501
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$881.50 |
| Max. Negotiated Rate |
$881.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$881.50
|
|
