|
HC SARS-COV-2 COVID-19 AMP PRB
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT U0003
|
| Hospital Charge Code |
306U000303
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
|
|
HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
3028676901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$56.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.13
|
| Rate for Payer: Aetna Government |
$42.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$29.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$29.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29.49
|
| Rate for Payer: Brighton Health Commercial |
$33.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$42.13
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$42.13
|
| Rate for Payer: EmblemHealth Commercial |
$42.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$37.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$35.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$37.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$42.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$37.50
|
| Rate for Payer: Group Health Inc Commercial |
$42.13
|
| Rate for Payer: Group Health Inc Medicare |
$42.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.28
|
| Rate for Payer: Healthfirst Essential Plan |
$56.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$42.13
|
| Rate for Payer: Healthfirst QHP |
$42.13
|
| Rate for Payer: Humana Medicare |
$42.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$42.13
|
| Rate for Payer: United Healthcare Commercial |
$37.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$42.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.28
|
| Rate for Payer: Wellcare Medicare |
$37.92
|
|
|
HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
3028676901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.50
|
|
|
HC SARS-COV-2 COVID-19 SBH
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87635 QW
|
| Hospital Charge Code |
3068763503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$51.31
|
| Rate for Payer: Aetna Government |
$51.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$35.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$35.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$35.92
|
| Rate for Payer: Brighton Health Commercial |
$97.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$51.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$51.31
|
| Rate for Payer: EmblemHealth Commercial |
$51.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$46.18
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$43.61
|
| Rate for Payer: Fidelis Essential Plan QHP |
$45.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$51.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$45.67
|
| Rate for Payer: Group Health Inc Commercial |
$51.31
|
| Rate for Payer: Group Health Inc Medicare |
$51.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$51.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.79
|
| Rate for Payer: Healthfirst Essential Plan |
$69.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$51.31
|
| Rate for Payer: Healthfirst QHP |
$51.31
|
| Rate for Payer: Humana Medicare |
$52.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$51.31
|
| Rate for Payer: United Healthcare Commercial |
$46.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$51.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$30.79
|
| Rate for Payer: Wellcare Medicare |
$46.18
|
|
|
HC SARS-COV-2 COVID-19 SBH
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87635 QW
|
| Hospital Charge Code |
3068763503
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
|
|
HC SARS-COV-2 XP XPRESS COVID-19-SBH
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT U0003
|
| Hospital Charge Code |
306U000302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$75.00
|
| Rate for Payer: Aetna Government |
$75.00
|
| Rate for Payer: Brighton Health Commercial |
$97.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: EmblemHealth Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Commercial |
$65.00
|
| Rate for Payer: Group Health Inc Medicare |
$45.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
HC SARS-COV-2 XP XPRESS COVID-19-SBH
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT U0003
|
| Hospital Charge Code |
306U000302
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
|
|
HC SARS COVID-19 ANTIGEN DETECTION
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
3068742601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$65.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.00
|
|
|
HC SARS COVID-19 ANTIGEN DETECTION
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
3068742601
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.33
|
| Rate for Payer: Aetna Government |
$35.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.73
|
| Rate for Payer: Brighton Health Commercial |
$97.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$88.40
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.33
|
| Rate for Payer: EmblemHealth Commercial |
$35.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.03
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.44
|
| Rate for Payer: Group Health Inc Commercial |
$35.33
|
| Rate for Payer: Group Health Inc Medicare |
$35.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27.14
|
| Rate for Payer: Healthfirst Essential Plan |
$61.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.33
|
| Rate for Payer: Healthfirst QHP |
$35.33
|
| Rate for Payer: Humana Medicare |
$36.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare Commercial |
$40.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27.14
|
| Rate for Payer: Wellcare Medicare |
$31.80
|
|
|
HC SB SCOPE,CONVRT GASTRO TO JEJUN - ENTEROSCOPY
|
Facility
|
IP
|
$4,716.00
|
|
|
Service Code
|
CPT 44373 TC
|
| Hospital Charge Code |
3614437301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,358.00 |
| Max. Negotiated Rate |
$2,358.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
|
|
HC SB SCOPE,CONVRT GASTRO TO JEJUN - ENTEROSCOPY
|
Facility
|
OP
|
$4,716.00
|
|
|
Service Code
|
CPT 44373 TC
|
| Hospital Charge Code |
3614437301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.09 |
| Max. Negotiated Rate |
$3,537.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.09
|
| Rate for Payer: Aetna Government |
$231.09
|
| Rate for Payer: Brighton Health Commercial |
$3,537.00
|
| 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 |
$2,358.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,358.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,650.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,358.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$864.15
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
|
|
HC SBSQ PSYC COLLAB CARE MGMT
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
9009949301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$118.50
|
|
|
HC SBSQ PSYC COLLAB CARE MGMT
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 99493
|
| Hospital Charge Code |
9009949301
|
|
Hospital Revenue Code
|
900
|
| Min. Negotiated Rate |
$79.11 |
| Max. Negotiated Rate |
$189.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$130.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$113.02
|
| Rate for Payer: Aetna Government |
$113.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$79.11
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$79.11
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$79.11
|
| Rate for Payer: Brighton Health Commercial |
$177.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$113.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$189.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$161.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$113.02
|
| Rate for Payer: EmblemHealth Commercial |
$113.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$96.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$100.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$113.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$100.59
|
| Rate for Payer: Group Health Inc Commercial |
$113.02
|
| Rate for Payer: Group Health Inc Medicare |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$113.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$113.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$96.07
|
| Rate for Payer: Healthfirst QHP |
$113.02
|
| Rate for Payer: Humana Medicare |
$115.28
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$118.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$113.02
|
| Rate for Payer: United Healthcare Commercial |
$118.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$113.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$107.37
|
| Rate for Payer: Wellcare Medicare |
$107.37
|
|
|
HC SC INFUSION, THERAPY, ADD'L PUMP SET UP
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
2609637101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.87 |
| Max. Negotiated Rate |
$146.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$86.96
|
| Rate for Payer: Aetna Government |
$86.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$60.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$60.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$60.87
|
| Rate for Payer: Brighton Health Commercial |
$137.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$86.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$146.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$86.96
|
| Rate for Payer: EmblemHealth Commercial |
$86.96
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$78.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$77.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$77.39
|
| Rate for Payer: Group Health Inc Commercial |
$86.96
|
| Rate for Payer: Group Health Inc Medicare |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$86.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$86.96
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$86.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$82.61
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC SC INFUSION, THERAPY, ADD'L PUMP SET UP
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
2609637101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
3614918501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
3614918501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.59 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$1,385.25
|
| 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 |
$1,979.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$133.59
|
| 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 SCOPE THRU TRACHEOSTOMY
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
3613161501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$1,002.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$622.21
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| Rate for Payer: Group Health Inc Commercial |
$622.21
|
| Rate for Payer: Group Health Inc Medicare |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$132.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC SCOPE THRU TRACHEOSTOMY
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
3613161501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
4037706702
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.81
|
| Rate for Payer: Aetna Government |
$78.81
|
| Rate for Payer: Brighton Health Commercial |
$301.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$273.36
|
| Rate for Payer: EmblemHealth Commercial |
$96.97
|
| Rate for Payer: Group Health Inc Commercial |
$201.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.97
|
| Rate for Payer: Healthfirst Essential Plan |
$234.94
|
| Rate for Payer: United Healthcare Commercial |
$83.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.42
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
4037706702
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
4037706701
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING BILATERAL
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
4037706701
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.81
|
| Rate for Payer: Aetna Government |
$78.81
|
| Rate for Payer: Brighton Health Commercial |
$301.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$273.36
|
| Rate for Payer: EmblemHealth Commercial |
$96.97
|
| Rate for Payer: Group Health Inc Commercial |
$201.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.97
|
| Rate for Payer: Healthfirst Essential Plan |
$234.94
|
| Rate for Payer: United Healthcare Commercial |
$83.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.42
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING RIGHT
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
4037706703
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$321.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$221.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.81
|
| Rate for Payer: Aetna Government |
$78.81
|
| Rate for Payer: Brighton Health Commercial |
$301.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$321.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$273.36
|
| Rate for Payer: EmblemHealth Commercial |
$96.97
|
| Rate for Payer: Group Health Inc Commercial |
$201.00
|
| Rate for Payer: Group Health Inc Medicare |
$140.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$201.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$96.97
|
| Rate for Payer: Healthfirst Essential Plan |
$234.94
|
| Rate for Payer: United Healthcare Commercial |
$83.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$104.42
|
|
|
HC SCR MAMMO BI INCL CAD - MAMMO BREAST SCREENING RIGHT
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
4037706703
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$201.00 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$201.00
|
|
