|
HC STRAPPING OF TOE(S)
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
7612955001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
|
|
HC STRAPPING OF TOE(S)
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
7612955001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$127.50
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$12.18
|
| 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 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 STRAPPING OF TOE(S) - PT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
4202955001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
|
|
HC STRAPPING OF TOE(S) - PT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
4202955001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$182.00
|
| 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 |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72.58
|
| 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 |
$120.00
|
| 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 |
$12.18
|
| 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 |
$222.00
|
| 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 |
$55.00
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
3612958001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
3612958001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$303.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| 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 |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$192.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| Rate for Payer: Group Health Inc Commercial |
$192.79
|
| Rate for Payer: Group Health Inc Medicare |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
5102958001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC STRAPPING UNNA BOOT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
5102958001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC STRAPPING UNNA BOOT - OT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
4302958001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC STRAPPING UNNA BOOT - OT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
4302958001
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$192.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| Rate for Payer: Group Health Inc Commercial |
$192.79
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC STRAPPING UNNA BOOT - PT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
4202958001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC STRAPPING UNNA BOOT - PT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
4202958001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.25 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$192.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| Rate for Payer: Group Health Inc Commercial |
$192.79
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC STRATTICE, PER SQ CM
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT Q4130
|
| Hospital Charge Code |
636Q413001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.00
|
|
|
HC STRATTICE, PER SQ CM
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT Q4130
|
| Hospital Charge Code |
636Q413001
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$48.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.94
|
| Rate for Payer: Aetna Government |
$13.94
|
| Rate for Payer: Brighton Health Commercial |
$52.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$44.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.60
|
| Rate for Payer: EmblemHealth Commercial |
$44.00
|
| Rate for Payer: Group Health Inc Commercial |
$44.00
|
| Rate for Payer: Group Health Inc Medicare |
$30.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$44.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$44.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57.20
|
|
|
HC STREP A ASSAY W/OPTIC - POCT RAPID STREP A
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3068788002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.53
|
| Rate for Payer: Aetna Government |
$16.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.57
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.53
|
| Rate for Payer: EmblemHealth Commercial |
$16.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.71
|
| Rate for Payer: Group Health Inc Commercial |
$16.53
|
| Rate for Payer: Group Health Inc Medicare |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Healthfirst Essential Plan |
$8.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.53
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: Humana Medicare |
$16.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Wellcare Medicare |
$14.88
|
|
|
HC STREP A ASSAY W/OPTIC - POCT RAPID STREP A
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3068788002
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3068788001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.53
|
| Rate for Payer: Aetna Government |
$16.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.57
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.53
|
| Rate for Payer: EmblemHealth Commercial |
$16.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.88
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.05
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.71
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.71
|
| Rate for Payer: Group Health Inc Commercial |
$16.53
|
| Rate for Payer: Group Health Inc Medicare |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Healthfirst Essential Plan |
$8.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.53
|
| Rate for Payer: Healthfirst QHP |
$16.53
|
| Rate for Payer: Humana Medicare |
$16.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.79
|
| Rate for Payer: Wellcare Medicare |
$14.88
|
|
|
HC STREP A ASSAY W/OPTIC - RAPID STREP A SCREEN
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3068788001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC STREP B, DNA, AMP PROBE - STREP B DNA PROBE, AMPLIFICATION
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87653
|
| Hospital Charge Code |
3068765301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$65.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Healthfirst Essential Plan |
$48.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$44.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21.64
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
|
HC STREP B, DNA, AMP PROBE - STREP B DNA PROBE, AMPLIFICATION
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 87653
|
| Hospital Charge Code |
3068765301
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC STRESS TEST (FETAL CONTRACTION)
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 59020 TC
|
| Hospital Charge Code |
7205902001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$33.32 |
| Max. Negotiated Rate |
$8,223.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.75
|
| Rate for Payer: Aetna Government |
$39.75
|
| Rate for Payer: Brighton Health Commercial |
$376.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$401.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$341.36
|
| Rate for Payer: EmblemHealth Commercial |
$251.00
|
| Rate for Payer: Group Health Inc Commercial |
$251.00
|
| Rate for Payer: Group Health Inc Medicare |
$175.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$8,223.00
|
|
|
HC STRESS TEST (FETAL CONTRACTION)
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 59020 TC
|
| Hospital Charge Code |
7205902001
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC STRESS TTE ONLY - COMPLETE ECHOCARDIOGRAM EXERCISE STRESS TEST
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4839335005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
|
HC STRESS TTE ONLY - COMPLETE ECHOCARDIOGRAM EXERCISE STRESS TEST
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4839335005
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$207.33 |
| Max. Negotiated Rate |
$1,166.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$669.92
|
| Rate for Payer: Aetna Government |
$669.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$468.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$468.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$468.94
|
| Rate for Payer: Brighton Health Commercial |
$1,093.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$669.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,166.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$991.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$669.92
|
| Rate for Payer: EmblemHealth Commercial |
$669.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$602.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$669.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.23
|
| Rate for Payer: Group Health Inc Commercial |
$669.92
|
| Rate for Payer: Group Health Inc Medicare |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$669.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$669.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$207.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.43
|
| Rate for Payer: Healthfirst QHP |
$669.92
|
| Rate for Payer: Humana Medicare |
$683.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$669.92
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$669.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$669.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.42
|
| Rate for Payer: Wellcare Medicare |
$636.42
|
|
|
HC STRESS TTE ONLY - ECHOCARDIOGRAM DOBUTAMINE STRESS TEST
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4839335002
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$729.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$729.00
|
|
