|
HC RT MDI/DPI
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
4109464002
|
|
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 NASAL CPAP
|
Facility
|
OP
|
$557.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466005
|
|
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 NASAL CPAP
|
Facility
|
IP
|
$557.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
4109466005
|
|
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 NON-INVASIVE VENT MGMT, INITIAL DAY
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400204
|
|
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 NON-INVASIVE VENT MGMT, INITIAL DAY
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400204
|
|
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 NON-INVASIVE VENT MGMT, SUBSEQ DAY
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400302
|
|
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 NON-INVASIVE VENT MGMT, SUBSEQ DAY
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400302
|
|
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 NONINVASV OXYGEN SATUR,MULTIPLE
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
4109476101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC RT NONINVASV OXYGEN SATUR,MULTIPLE
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
4109476101
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$4.61 |
| Max. Negotiated Rate |
$165.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.61
|
| Rate for Payer: Aetna Government |
$4.61
|
| Rate for Payer: Brighton Health Commercial |
$116.25
|
| 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 |
$77.50
|
| Rate for Payer: Group Health Inc Commercial |
$77.50
|
| Rate for Payer: Group Health Inc Medicare |
$54.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$77.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.89
|
| Rate for Payer: United Healthcare Commercial |
$77.50
|
|
|
HC RT NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
4109476001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.50
|
|
|
HC RT NONINVASV OXYGEN SATUR;SINGLE
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
4109476001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$165.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.02
|
| Rate for Payer: Aetna Government |
$3.02
|
| Rate for Payer: Brighton Health Commercial |
$105.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$165.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.51
|
| Rate for Payer: EmblemHealth Commercial |
$70.50
|
| Rate for Payer: Group Health Inc Commercial |
$70.50
|
| Rate for Payer: Group Health Inc Medicare |
$49.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$4.50
|
| Rate for Payer: United Healthcare Commercial |
$70.50
|
|
|
HC RT NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
4109476201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$194.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$85.25
|
| 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 |
$116.25
|
| 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 |
$28.95
|
| 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 |
$77.50
|
| 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 NONINVASV OXYGEN SATUT,CONTINUOUS
|
Facility
|
IP
|
$155.00
|
|
|
Service Code
|
CPT 94762
|
| Hospital Charge Code |
4109476201
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$77.50
|
|
|
HC RT PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX /SESSION
|
Facility
|
OP
|
$1,394.00
|
|
|
Service Code
|
CPT 99183
|
| Hospital Charge Code |
4139918301
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$96.87 |
| Max. Negotiated Rate |
$3,163.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$766.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$96.87
|
| Rate for Payer: Aetna Government |
$96.87
|
| Rate for Payer: Brighton Health Commercial |
$1,045.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,115.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$947.92
|
| Rate for Payer: EmblemHealth Commercial |
$697.00
|
| Rate for Payer: Group Health Inc Commercial |
$697.00
|
| Rate for Payer: Group Health Inc Medicare |
$487.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$697.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$119.65
|
| Rate for Payer: United Healthcare Commercial |
$3,163.00
|
|
|
HC RT PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX /SESSION
|
Facility
|
IP
|
$1,394.00
|
|
|
Service Code
|
CPT 99183
|
| Hospital Charge Code |
4139918301
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$697.00 |
| Max. Negotiated Rate |
$697.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.00
|
|
|
HC RT VENTILATOR TRANSPORT
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400202
|
|
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 VENTILATOR TRANSPORT
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400202
|
|
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 VENT MGMT, INPATIENT, INITIAL DAY
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400201
|
|
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 VENT MGMT, INPATIENT, INITIAL DAY
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
4109400201
|
|
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 VENT MGMT, INPATIENT, SUBQ DAY
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400301
|
|
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 VENT MGMT, INPATIENT, SUBQ DAY
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
4109400301
|
|
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 VENTRICULAR RESECT, INFUNDIBULAR STENOSIS
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
CPT 33476
|
| Hospital Charge Code |
3613347601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,251.00 |
| Max. Negotiated Rate |
$2,251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,251.00
|
|
|
HC RT VENTRICULAR RESECT, INFUNDIBULAR STENOSIS
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
CPT 33476
|
| Hospital Charge Code |
3613347601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,376.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,476.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,717.69
|
| Rate for Payer: Aetna Government |
$1,717.69
|
| Rate for Payer: Brighton Health Commercial |
$3,376.50
|
| 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 |
$2,251.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,251.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,575.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,251.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,790.27
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC RT VITAL CAPACITY TEST
|
Facility
|
IP
|
$436.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4109415001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$218.00 |
| Max. Negotiated Rate |
$218.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$218.00
|
|
|
HC RT VITAL CAPACITY TEST
|
Facility
|
OP
|
$436.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
4109415001
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$133.82 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$239.80
|
| 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 |
$327.00
|
| 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 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 |
$218.00
|
| 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
|
|
