|
PUMP IZ/PRE-CONNECTED (72404238)
|
Facility
|
OP
|
$21,585.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64905005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$22,664.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,871.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$12,951.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,792.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,411.38
|
| Rate for Payer: EmblemHealth Commercial |
$10,792.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,664.25
|
| Rate for Payer: Group Health Inc Commercial |
$10,792.50
|
| Rate for Payer: Group Health Inc Medicare |
$7,554.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,792.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,792.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,030.25
|
|
|
PUMP LARGE (72404252)
|
Facility
|
IP
|
$20,925.45
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,462.72 |
| Max. Negotiated Rate |
$10,462.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,462.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,462.72
|
|
|
PUMP LARGE (72404252)
|
Facility
|
OP
|
$20,925.45
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903240
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$21,971.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,509.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$12,555.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,462.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,032.13
|
| Rate for Payer: EmblemHealth Commercial |
$10,462.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,971.72
|
| Rate for Payer: Group Health Inc Commercial |
$10,462.72
|
| Rate for Payer: Group Health Inc Medicare |
$7,323.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,462.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,462.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,601.54
|
|
|
PUMP PENILE 21CML SALINE-FILLE
|
Facility
|
OP
|
$21,585.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$22,664.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,871.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$12,951.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,792.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,411.38
|
| Rate for Payer: EmblemHealth Commercial |
$10,792.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,664.25
|
| Rate for Payer: Group Health Inc Commercial |
$10,792.50
|
| Rate for Payer: Group Health Inc Medicare |
$7,554.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,792.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,792.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,030.25
|
|
|
PUMP PENILE 21CML SALINE-FILLE
|
Facility
|
IP
|
$21,585.00
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64903164
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,792.50 |
| Max. Negotiated Rate |
$10,792.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,792.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10,792.50
|
|
|
PUMP URETHRAL F/URINARY CONTROL
|
Facility
|
IP
|
$12,657.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64902922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,328.75 |
| Max. Negotiated Rate |
$6,328.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,328.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,328.75
|
|
|
PUMP URETHRAL F/URINARY CONTROL
|
Facility
|
OP
|
$12,657.50
|
|
|
Service Code
|
HCPCS C1813
|
| Hospital Charge Code |
64902922
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,775.00 |
| Max. Negotiated Rate |
$13,290.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6,961.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,775.00
|
| Rate for Payer: Aetna Government |
$3,775.00
|
| Rate for Payer: Brighton Health Commercial |
$7,594.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6,328.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7,278.06
|
| Rate for Payer: EmblemHealth Commercial |
$6,328.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,290.38
|
| Rate for Payer: Group Health Inc Commercial |
$6,328.75
|
| Rate for Payer: Group Health Inc Medicare |
$4,430.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,328.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,328.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,227.38
|
|
|
PUNCH BIOPSY 2MM DISP
|
Facility
|
OP
|
$2.98
|
|
| Hospital Charge Code |
64903343
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.49
|
| Rate for Payer: Aetna Government |
$1.49
|
| Rate for Payer: Brighton Health Commercial |
$2.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.03
|
| Rate for Payer: Group Health Inc Commercial |
$1.49
|
| Rate for Payer: Group Health Inc Medicare |
$1.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.49
|
|
|
Punch biopsy of skin (including simple closure, when performed); single lesion
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.78 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$461.12
|
| Rate for Payer: Group Health Inc Medicare |
$461.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
30307916
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.39
|
| Rate for Payer: Aetna Government |
$23.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| 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 |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
42501053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.39
|
| Rate for Payer: Aetna Government |
$23.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| 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 |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
PUNCH BX SKIN EA SEP/ADDL
|
Facility
|
OP
|
$356.37
|
|
|
Service Code
|
HCPCS 11105
|
| Hospital Charge Code |
42201204
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.39 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.39
|
| Rate for Payer: Aetna Government |
$23.39
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| 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 |
$178.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.18
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
PUNCH BX SKIN SGL LES
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
42201203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PUNCH BX SKIN SGL LES
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
42201203
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
66543701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.62 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: EmblemHealth Commercial |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| Rate for Payer: Group Health Inc Commercial |
$461.12
|
| Rate for Payer: Group Health Inc Medicare |
$461.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
42501052
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
66543701
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
30307915
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
42501052
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 11104
|
| Hospital Charge Code |
30307915
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
PUNCH STR
|
Facility
|
OP
|
$925.75
|
|
| Hospital Charge Code |
64907264
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$324.01 |
| Max. Negotiated Rate |
$740.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$509.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$462.88
|
| Rate for Payer: Aetna Government |
$462.88
|
| Rate for Payer: Brighton Health Commercial |
$694.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$740.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$629.51
|
| Rate for Payer: Group Health Inc Commercial |
$462.88
|
| Rate for Payer: Group Health Inc Medicare |
$324.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$462.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$462.88
|
|
|
PUNCT ASPIRATION OF CYST BREAST
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
30105374
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
PUNCT ASPIRATION OF CYST BREAST
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
30105374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$813.63
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
PUNCT. ASPIRATION OF CYST BREAST
|
Facility
|
OP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
30300181
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$813.63
|
| Rate for Payer: Aetna Government |
$813.63
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$569.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$569.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$569.54
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Cash Price |
$813.63
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$813.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$691.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$724.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$813.63
|
| Rate for Payer: Fidelis Qualified Health Plan |
$724.13
|
| 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 |
$923.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$813.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$691.59
|
| Rate for Payer: Healthfirst QHP |
$813.63
|
| Rate for Payer: Humana Medicare |
$829.90
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$813.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$813.63
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$813.63
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$813.63
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$650.90
|
| Rate for Payer: Wellcare Medicare |
$772.95
|
|
|
PUNCT. ASPIRATION OF CYST BREAST
|
Facility
|
IP
|
$1,847.58
|
|
|
Service Code
|
HCPCS 19000
|
| Hospital Charge Code |
30300181
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$813.63
|
|
