|
HC STRESS TTE ONLY - ECHOCARDIOGRAM DOBUTAMINE STRESS TEST
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4839335002
|
|
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 EXERCISE STRESS TEST
|
Facility
|
IP
|
$1,458.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4839335003
|
|
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 - ECHOCARDIOGRAM EXERCISE STRESS TEST
|
Facility
|
OP
|
$1,458.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
4839335003
|
|
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 ST THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
4409712901
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$76.50
|
|
|
HC ST THER IVNTJ COG FUNCJ CNTCT 1ST 15 MINUTES
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 97129 GN
|
| Hospital Charge Code |
4409712901
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.42
|
| Rate for Payer: Aetna Government |
$14.42
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$150.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$150.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$67.05
|
| Rate for Payer: Amida Care Medicaid |
$67.05
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: EmblemHealth Commercial |
$76.50
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$150.85
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$67.05
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$67.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$150.85
|
| Rate for Payer: Fidelis Essential Plan QHP |
$150.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$70.40
|
| Rate for Payer: Group Health Inc Commercial |
$76.50
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$67.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$67.05
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.05
|
| Rate for Payer: Healthfirst Essential Plan |
$150.85
|
| Rate for Payer: Healthfirst QHP |
$109.28
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$67.05
|
| Rate for Payer: SOMOS Essential |
$150.85
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$150.85
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$73.75
|
| Rate for Payer: United Healthcare Medicaid |
$67.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$67.05
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC SUBC INJ FILLING MARTRL >10.0CC
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 11954
|
| Hospital Charge Code |
3611195401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.69 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| 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 |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC SUBC INJ FILLING MARTRL >10.0CC
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 11954
|
| Hospital Charge Code |
3611195401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC SUBC INJ FILLING MARTRL <1.0CC
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
3611195001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$380.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$60.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC SUBC INJ FILLING MARTRL <1.0CC
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 11950
|
| Hospital Charge Code |
3611195001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$253.50 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$253.50
|
|
|
HC SUBC INJ FILLING MARTRL 1.1 TO 5.0 CC
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 11951
|
| Hospital Charge Code |
3611195101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.46 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| 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 |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$84.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC SUBC INJ FILLING MARTRL 1.1 TO 5.0 CC
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 11951
|
| Hospital Charge Code |
3611195101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
2609637001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,EA ADD HOUR
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96370
|
| Hospital Charge Code |
2609637001
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$761.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56.37
|
| Rate for Payer: Aetna Government |
$56.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$338.44
|
| Rate for Payer: Amida Care Medicaid |
$338.44
|
| Rate for Payer: Brighton Health Commercial |
$86.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$56.37
|
| Rate for Payer: EmblemHealth Commercial |
$56.37
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$761.50
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$338.44
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$761.50
|
| Rate for Payer: Fidelis Essential Plan QHP |
$761.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$355.36
|
| Rate for Payer: Group Health Inc Commercial |
$56.37
|
| Rate for Payer: Group Health Inc Medicare |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$338.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Healthfirst Essential Plan |
$761.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$551.66
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$338.44
|
| Rate for Payer: SOMOS Essential |
$761.50
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$761.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$372.28
|
| Rate for Payer: United Healthcare Medicaid |
$338.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$338.44
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
2609636901
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC SUBCUT INFUSION, THERAP/PROPH/DIAGNOST,INITIAL,1ST HOUR
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96369
|
| Hospital Charge Code |
2609636901
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$444.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.43
|
| Rate for Payer: Aetna Government |
$257.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.20
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$444.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.43
|
| Rate for Payer: EmblemHealth Commercial |
$257.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.11
|
| Rate for Payer: Group Health Inc Commercial |
$257.43
|
| Rate for Payer: Group Health Inc Medicare |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.82
|
| Rate for Payer: Healthfirst QHP |
$257.43
|
| Rate for Payer: Humana Medicare |
$262.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.43
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$244.56
|
| Rate for Payer: Wellcare Medicare |
$244.56
|
|
|
HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
3611527502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC SUB GRFT F/S/N/H/F/G/M/D /<100SCM /<1ST 25 SCM
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
3611527502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.95 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$88.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC SUBS ABUSE SCREENING/INTER, 15-30 MINS
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
5109940801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$55.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.76
|
| Rate for Payer: Aetna Government |
$24.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC SUBS ABUSE SCREENING/INTER, 15-30 MINS
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 99408
|
| Hospital Charge Code |
5109940801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$50.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.00
|
|
|
HC SUGARS SINGLE QUANTITATIVE, EACH SPECIMEN - 1,5-ANHYDROGLUCITOL
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
3018437801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$25.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Healthfirst Essential Plan |
$25.94
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.53
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HC SUGARS SINGLE QUANTITATIVE, EACH SPECIMEN - 1,5-ANHYDROGLUCITOL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 84378
|
| Hospital Charge Code |
3018437801
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC SUPRACERV ABD HYSTERECTOMY
|
Facility
|
OP
|
$8,790.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
3615818001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,116.17 |
| Max. Negotiated Rate |
$6,592.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,834.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,196.04
|
| Rate for Payer: Aetna Government |
$1,196.04
|
| Rate for Payer: Brighton Health Commercial |
$6,592.50
|
| 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 |
$4,395.00
|
| Rate for Payer: Group Health Inc Commercial |
$4,395.00
|
| Rate for Payer: Group Health Inc Medicare |
$3,076.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,395.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,395.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,116.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC SUPRACERV ABD HYSTERECTOMY
|
Facility
|
IP
|
$8,790.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
3615818001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,395.00 |
| Max. Negotiated Rate |
$4,395.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,395.00
|
|
|
HC SURGERY ELECTROCORTICOGRAM - ELECTROCORTICOGRAM AT SURGERY
|
Facility
|
OP
|
$1,787.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
7409582901
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$625.45 |
| Max. Negotiated Rate |
$2,007.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$982.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,682.27
|
| Rate for Payer: Aetna Government |
$1,682.27
|
| Rate for Payer: Brighton Health Commercial |
$1,340.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,429.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,215.16
|
| Rate for Payer: EmblemHealth Commercial |
$893.50
|
| Rate for Payer: Group Health Inc Commercial |
$893.50
|
| Rate for Payer: Group Health Inc Medicare |
$625.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$893.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$893.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,007.68
|
| Rate for Payer: United Healthcare Commercial |
$822.00
|
|
|
HC SURGERY ELECTROCORTICOGRAM - ELECTROCORTICOGRAM AT SURGERY
|
Facility
|
IP
|
$1,787.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
7409582901
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$893.50 |
| Max. Negotiated Rate |
$893.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$893.50
|
|
