|
HC RT DEMO &/OR EVAL,PT USE,AEROSOL DEVICE
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4109466401
|
|
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 DEMO &/OR EVAL,PT USE,AEROSOL DEVICE
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
4109466401
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$21.42 |
| 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 |
$21.42
|
| 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 EVAL OF BRONCHOSPASM
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
4109406001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$373.50 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$373.50
|
|
|
HC RT EVAL OF BRONCHOSPASM
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
4109406001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$560.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$410.85
|
| 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 |
$560.25
|
| 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 |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| 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 |
$44.91
|
| 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 |
$373.50
|
| 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 RT EXHALED AIR ANALYSIS: O2, CO2
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
4609468101
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC RT EXHALED AIR ANALYSIS: O2, CO2
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
4609468101
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.71 |
| 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 |
$55.71
|
| 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 RT EXHALED AIR ANALYSIS: O2, CO2
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
4109468101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$419.50 |
| Max. Negotiated Rate |
$419.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$419.50
|
|
|
HC RT EXHALED AIR ANALYSIS: O2, CO2
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 94681
|
| Hospital Charge Code |
4109468101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$55.71 |
| Max. Negotiated Rate |
$629.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$380.47
|
| Rate for Payer: Aetna Government |
$380.47
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$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 |
$629.25
|
| 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 |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| 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 |
$55.71
|
| 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 |
$419.50
|
| 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 RT HAND HELD NEBULIZER
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464004
|
|
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 HAND HELD NEBULIZER
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464004
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$9.55 |
| 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 |
$9.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.23
|
| Rate for Payer: Healthfirst QHP |
$248.51
|
| Rate for Payer: Humana Medicare |
$253.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.51
|
| Rate for Payer: United Healthcare Commercial |
$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 HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4109295001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$383.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$383.00
|
|
|
HC RT HEART/LUNG RESUSCITATION (CPR)
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
4109295001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$140.51 |
| Max. Negotiated Rate |
$574.50 |
| 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 |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| 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 |
$202.50
|
| 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 RT HIGH FREQ OSCILLATION INTITAL DAY
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400203
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.57 |
| Max. Negotiated Rate |
$1,112.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$815.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$807.75
|
| Rate for Payer: Aetna Government |
$807.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$565.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$565.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$565.42
|
| Rate for Payer: Brighton Health Commercial |
$1,112.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$807.75
|
| 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 |
$807.75
|
| Rate for Payer: EmblemHealth Commercial |
$807.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$718.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$807.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$718.90
|
| Rate for Payer: Group Health Inc Commercial |
$807.75
|
| Rate for Payer: Group Health Inc Medicare |
$807.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$807.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$807.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$100.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$686.59
|
| Rate for Payer: Healthfirst QHP |
$807.75
|
| Rate for Payer: Humana Medicare |
$823.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$807.75
|
| Rate for Payer: United Healthcare Commercial |
$741.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$807.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$807.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$767.36
|
| Rate for Payer: Wellcare Medicare |
$767.36
|
|
|
HC RT HIGH FREQ OSCILLATION INTITAL DAY
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400203
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$741.50 |
| Max. Negotiated Rate |
$741.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.50
|
|
|
HC RT HIGH FREQ OSCILLAT SUBSEQ DAY
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400303
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.92 |
| Max. Negotiated Rate |
$1,112.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$815.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$807.75
|
| Rate for Payer: Aetna Government |
$807.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$565.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$565.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$565.42
|
| Rate for Payer: Brighton Health Commercial |
$1,112.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$807.75
|
| 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 |
$807.75
|
| Rate for Payer: EmblemHealth Commercial |
$807.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$726.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$686.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$718.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$807.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$718.90
|
| Rate for Payer: Group Health Inc Commercial |
$807.75
|
| Rate for Payer: Group Health Inc Medicare |
$807.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$807.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$807.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$686.59
|
| Rate for Payer: Healthfirst QHP |
$807.75
|
| Rate for Payer: Humana Medicare |
$823.90
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$807.75
|
| Rate for Payer: United Healthcare Commercial |
$741.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$807.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$807.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$767.36
|
| Rate for Payer: Wellcare Medicare |
$767.36
|
|
|
HC RT HIGH FREQ OSCILLAT SUBSEQ DAY
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400303
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$741.50 |
| Max. Negotiated Rate |
$741.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$741.50
|
|
|
HC RT INDUCED SPUTUM
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464003
|
|
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 INDUCED SPUTUM
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$9.55 |
| 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 |
$9.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.23
|
| Rate for Payer: Healthfirst QHP |
$248.51
|
| Rate for Payer: Humana Medicare |
$253.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.51
|
| Rate for Payer: United Healthcare Commercial |
$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 INHALATION TREATMENT
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464001
|
|
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 INHALATION TREATMENT
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$9.55 |
| 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 |
$9.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$211.23
|
| Rate for Payer: Healthfirst QHP |
$248.51
|
| Rate for Payer: Humana Medicare |
$253.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$248.51
|
| Rate for Payer: United Healthcare Commercial |
$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 INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
4609461001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$445.60 |
| 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 |
$445.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.76
|
| 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 |
$60.59
|
| 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 INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
4609461001
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$278.50 |
| Max. Negotiated Rate |
$278.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.50
|
|
|
HC RT LUNG FUNCTION TEST (MBC/MVV)
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
4109420001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
|
|
HC RT LUNG FUNCTION TEST (MBC/MVV)
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 94200
|
| Hospital Charge Code |
4109420001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$165.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$108.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$72.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC RT MDI/DPI
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464002
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$278.50 |
| Max. Negotiated Rate |
$278.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.50
|
|
