|
HC WEDGING OF CAST
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 29740
|
| Hospital Charge Code |
5102974001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| 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 |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$80.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC WEIGHT MGMT CLASS, NON PHYS PROVIDER
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT S9449
|
| Hospital Charge Code |
942S944901
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.77
|
| Rate for Payer: Aetna Government |
$42.77
|
| Rate for Payer: Brighton Health Commercial |
$15.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.60
|
| 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 |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
HC WEIGHT MGMT CLASS, NON PHYS PROVIDER
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT S9449
|
| Hospital Charge Code |
942S944901
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE ANTIBODIES, IGG AND IGM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
3028678801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE ANTIBODIES, IGG AND IGM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
3028678801
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.85
|
| Rate for Payer: Aetna Government |
$16.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.79
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.85
|
| Rate for Payer: EmblemHealth Commercial |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.85
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: Humana Medicare |
$17.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$21.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$15.16
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE VIRUS ANTIBODY, IGM
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
3028678802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
|
|
HC WEST NILE VIRUS AB, IGM - WEST NILE VIRUS ANTIBODY, IGM
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
3028678802
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.85
|
| Rate for Payer: Aetna Government |
$16.85
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.79
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.85
|
| Rate for Payer: EmblemHealth Commercial |
$16.85
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$15.16
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$14.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$15.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.85
|
| Rate for Payer: Fidelis Qualified Health Plan |
$15.00
|
| Rate for Payer: Group Health Inc Commercial |
$16.85
|
| Rate for Payer: Group Health Inc Medicare |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.85
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.85
|
| Rate for Payer: Healthfirst QHP |
$16.85
|
| Rate for Payer: Humana Medicare |
$17.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$21.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.85
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$15.16
|
|
|
HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
3028678901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
|
|
HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 86789
|
| Hospital Charge Code |
3028678901
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$32.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.39
|
| Rate for Payer: Aetna Government |
$14.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.07
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.58
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.39
|
| Rate for Payer: EmblemHealth Commercial |
$14.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.95
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.23
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.81
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.81
|
| Rate for Payer: Group Health Inc Commercial |
$14.39
|
| Rate for Payer: Group Health Inc Medicare |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Healthfirst Essential Plan |
$32.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.39
|
| Rate for Payer: Healthfirst QHP |
$14.39
|
| Rate for Payer: Humana Medicare |
$14.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.39
|
| Rate for Payer: Wellcare Medicare |
$12.95
|
|
|
HC WHOLE BLOOD, FOR TRANSFUSION, EACH UNIT
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
382P901001
|
|
Hospital Revenue Code
|
382
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.06
|
| Rate for Payer: Aetna Government |
$275.06
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$192.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$192.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$192.54
|
| Rate for Payer: Brighton Health Commercial |
$275.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$275.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$308.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$261.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$275.06
|
| Rate for Payer: EmblemHealth Commercial |
$275.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$247.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$233.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$244.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$275.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$244.80
|
| Rate for Payer: Group Health Inc Commercial |
$275.06
|
| Rate for Payer: Group Health Inc Medicare |
$275.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$275.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$275.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$233.80
|
| Rate for Payer: Healthfirst QHP |
$275.06
|
| Rate for Payer: Humana Medicare |
$280.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$275.06
|
| Rate for Payer: United Healthcare Commercial |
$192.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$275.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$275.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$261.31
|
| Rate for Payer: Wellcare Medicare |
$247.55
|
|
|
HC WHOLE BLOOD, FOR TRANSFUSION, EACH UNIT
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT P9010
|
| Hospital Charge Code |
382P901001
|
|
Hospital Revenue Code
|
382
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
|
|
HC WINDOWING OF CAST
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
5102973001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.58 |
| 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 |
$35.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51.73
|
| 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 WINDOWING OF CAST
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29730
|
| Hospital Charge Code |
5102973001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3613660003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$285.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC WITHDRAWAL OF ARTERIAL BLOOD
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3613660003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.50 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.50
|
|
|
HC WITHDRAWAL OF ARTERIAL BLOOD - BUNDLED CHARGE
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3613660002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.14 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$285.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| Rate for Payer: Group Health Inc Commercial |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC WITHDRAWAL OF ARTERIAL BLOOD - BUNDLED CHARGE
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3613660002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$190.50 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$190.50
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
272G016801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
272G016801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.49 |
| Max. Negotiated Rate |
$63.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$63.96
|
| Rate for Payer: Aetna Government |
$63.96
|
| Rate for Payer: Brighton Health Commercial |
$58.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.04
|
| Rate for Payer: EmblemHealth Commercial |
$39.00
|
| Rate for Payer: Group Health Inc Commercial |
$39.00
|
| Rate for Payer: Group Health Inc Medicare |
$27.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.49
|
|
|
HC WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3619760201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.95 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$290.95
|
| 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 |
$396.75
|
| 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 |
$423.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$359.72
|
| 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 |
$242.78
|
| 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 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 WOUND DEBRIDEMNT, NON-SELECTIVE, EA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3619760201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
|
|
HC X-RAY ABDOMEN,COMP ACUTE SERIES - XR ABDOMEN 2 VWS WITH CHEST 1 VIEW
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
3207402201
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.18 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$186.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.18
|
| Rate for Payer: Aetna Government |
$22.18
|
| Rate for Payer: Brighton Health Commercial |
$254.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$162.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.66
|
| Rate for Payer: EmblemHealth Commercial |
$36.54
|
| Rate for Payer: Group Health Inc Commercial |
$169.50
|
| Rate for Payer: Group Health Inc Medicare |
$118.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$169.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$169.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.54
|
| Rate for Payer: Healthfirst Essential Plan |
$70.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$31.17
|
|
|
HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$180.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.39
|
| Rate for Payer: Aetna Government |
$19.39
|
| Rate for Payer: Brighton Health Commercial |
$180.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.13
|
| Rate for Payer: EmblemHealth Commercial |
$21.17
|
| Rate for Payer: Group Health Inc Commercial |
$120.50
|
| Rate for Payer: Group Health Inc Medicare |
$84.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.17
|
| Rate for Payer: Healthfirst Essential Plan |
$55.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.86
|
|
|
HC X-RAY AC JTS - XR ACROMIOCLAVICULAR JOINTS BILATERAL
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
3207305001
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.50 |
| Max. Negotiated Rate |
$120.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.50
|
|
