|
HC THEAPUTIC ENEMA, AIR , CONTRAST FOR OBSTRUCTION REDUCTION
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 74283 TC
|
| Hospital Charge Code |
3207428301
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$275.50 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.50
|
|
|
HC THERAPEUTIC DRUG INJECTION, BY RE
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT D9610
|
| Hospital Charge Code |
361D961001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$29.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.47
|
| Rate for Payer: Aetna Government |
$14.47
|
| Rate for Payer: Brighton Health Commercial |
$27.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.16
|
| Rate for Payer: EmblemHealth Commercial |
$18.50
|
| Rate for Payer: Group Health Inc Commercial |
$18.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.50
|
|
|
HC THERAPEUTIC DRUG INJECTION, BY RE
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT D9610
|
| Hospital Charge Code |
361D961001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$18.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.50
|
|
|
HC THERAPEUTIC INTERVENT COGN FN EA ADDL 15 MINUTES
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 97130 GN
|
| Hospital Charge Code |
4409713001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.79
|
| Rate for Payer: Aetna Government |
$13.79
|
| 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 |
$30.50
|
| 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 |
$30.50
|
| 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 THERAPEUTIC INTERVENT COGN FN EA ADDL 15 MINUTES
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 97130 GN
|
| Hospital Charge Code |
4409713001
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$30.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.50
|
|
|
HC THER APHERESIS,PLASMA PHERESIS
|
Facility
|
IP
|
$4,008.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
3613651401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,004.00 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,004.00
|
|
|
HC THER APHERESIS,PLASMA PHERESIS
|
Facility
|
OP
|
$4,008.00
|
|
|
Service Code
|
CPT 36514
|
| Hospital Charge Code |
3613651401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.30 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,002.91
|
| Rate for Payer: Aetna Government |
$2,002.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,402.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,402.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,402.04
|
| Rate for Payer: Brighton Health Commercial |
$3,006.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,002.91
|
| 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 |
$2,002.91
|
| Rate for Payer: EmblemHealth Commercial |
$2,002.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,802.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,702.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,782.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,002.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,782.59
|
| Rate for Payer: Group Health Inc Commercial |
$2,002.91
|
| Rate for Payer: Group Health Inc Medicare |
$2,002.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,002.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$879.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$103.30
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,702.47
|
| Rate for Payer: Healthfirst QHP |
$2,002.91
|
| Rate for Payer: Humana Medicare |
$2,042.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,002.91
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,002.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,002.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,902.76
|
| Rate for Payer: Wellcare Medicare |
$1,902.76
|
|
|
HC THER APHERESIS,RED BLOOD CELLS
|
Facility
|
IP
|
$4,078.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
7613651201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,039.00 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,039.00
|
|
|
HC THER APHERESIS,RED BLOOD CELLS
|
Facility
|
OP
|
$4,078.00
|
|
|
Service Code
|
CPT 36512
|
| Hospital Charge Code |
7613651201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.14 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,002.91
|
| Rate for Payer: Aetna Government |
$2,002.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,402.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,402.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,402.04
|
| Rate for Payer: Brighton Health Commercial |
$3,058.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,002.91
|
| 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 |
$2,002.91
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,802.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,702.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,782.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,002.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,782.59
|
| 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 |
$2,002.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$879.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,702.47
|
| Rate for Payer: Healthfirst QHP |
$2,002.91
|
| Rate for Payer: Humana Medicare |
$2,042.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,002.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,002.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,002.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,902.76
|
| Rate for Payer: Wellcare Medicare |
$1,902.76
|
|
|
HC THER APHERESIS,WHITE BLOOD CELLS
|
Facility
|
IP
|
$4,078.00
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
7613651101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,039.00 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,039.00
|
|
|
HC THER APHERESIS,WHITE BLOOD CELLS
|
Facility
|
OP
|
$4,078.00
|
|
|
Service Code
|
CPT 36511
|
| Hospital Charge Code |
7613651101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,002.91
|
| Rate for Payer: Aetna Government |
$2,002.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,402.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,402.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,402.04
|
| Rate for Payer: Brighton Health Commercial |
$3,058.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,002.91
|
| 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 |
$2,002.91
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,802.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,702.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,782.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,002.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,782.59
|
| 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 |
$2,002.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$879.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.74
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,702.47
|
| Rate for Payer: Healthfirst QHP |
$2,002.91
|
| Rate for Payer: Humana Medicare |
$2,042.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,002.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,002.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,002.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,902.76
|
| Rate for Payer: Wellcare Medicare |
$1,902.76
|
|
|
HC THERASKIN PER SQ CM
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
636Q412101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.50
|
|
|
HC THERASKIN PER SQ CM
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
636Q412101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$52.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43.84
|
| Rate for Payer: Aetna Government |
$43.84
|
| Rate for Payer: Brighton Health Commercial |
$46.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$44.27
|
| Rate for Payer: EmblemHealth Commercial |
$38.50
|
| Rate for Payer: Group Health Inc Commercial |
$38.50
|
| Rate for Payer: Group Health Inc Medicare |
$26.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$38.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$50.05
|
|
|
HC THER/PROPH/DIAG INJECTION, IA
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
2609637301
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$21.61 |
| 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 |
$21.61
|
| 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 THER/PROPH/DIAG INJECTION, IA
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96373
|
| Hospital Charge Code |
2609637301
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC THER/PROPH/DIAG INJECTION, IV PUSH, EACH ADD'L, NEW DRUG
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
2609637501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$92.00 |
| 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 |
$39.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$39.46
|
| 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: Fidelis CHP/HARP/Medicaid |
$50.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$47.91
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$56.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$50.17
|
| 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 |
$56.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47.91
|
| Rate for Payer: Healthfirst QHP |
$56.37
|
| Rate for Payer: Humana Medicare |
$57.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56.37
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| 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 |
$53.55
|
| Rate for Payer: Wellcare Medicare |
$53.55
|
|
|
HC THER/PROPH/DIAG INJECTION, IV PUSH, EACH ADD'L, NEW DRUG
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
2609637501
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC THER/PROPH/DIAG INJECTION, IV PUSH, INITIAL
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
2609637401
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC THER/PROPH/DIAG INJECTION, IV PUSH, INITIAL
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
2609637401
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$40.43 |
| 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 |
$40.43
|
| 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 THER/PROPH/DIAG INJ, SC/IM
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
2609637201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$91.50 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$91.50
|
|
|
HC THER/PROPH/DIAG INJ, SC/IM
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
2609637201
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$13.36 |
| Max. Negotiated Rate |
$1,336.00 |
| 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 |
$30.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$30.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$13.36
|
| Rate for Payer: Amida Care Medicaid |
$13.36
|
| 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: EmblemHealth Essential Plan 1&2 |
$30.06
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$13.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$30.06
|
| Rate for Payer: Fidelis Essential Plan QHP |
$30.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$86.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.03
|
| 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 |
$13.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$86.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,336.00
|
| Rate for Payer: Healthfirst Essential Plan |
$30.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$73.92
|
| Rate for Payer: Healthfirst QHP |
$21.78
|
| Rate for Payer: Humana Medicare |
$88.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$86.96
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$13.36
|
| Rate for Payer: SOMOS Essential |
$30.06
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$30.06
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$14.70
|
| Rate for Payer: United Healthcare Medicaid |
$13.36
|
| 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 |
$13.36
|
| Rate for Payer: Wellcare Medicare |
$82.61
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 32555 TC
|
| Hospital Charge Code |
3613255501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.37 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.37
|
| Rate for Payer: Aetna Government |
$116.37
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| 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 |
$954.50
|
| Rate for Payer: Group Health Inc Commercial |
$954.50
|
| Rate for Payer: Group Health Inc Medicare |
$668.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.31
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 32555 TC
|
| Hospital Charge Code |
7613255501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.37 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.37
|
| Rate for Payer: Aetna Government |
$116.37
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| 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 |
$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 |
$954.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.31
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 32555 TC
|
| Hospital Charge Code |
7613255501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 32555 TC
|
| Hospital Charge Code |
3613255501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
