|
REMOVAL OF DENTAL IMPLANT SUPER
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
30307792
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
REMOVAL OF DENTAL IMPLANT SUPER
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
30307792
|
|
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 |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| 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 |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
REMOVAL OF DNETAL IMPLANT SUPER
|
Facility
|
OP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
30105785
|
|
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 |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,874.89
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Cash Price |
$1,874.89
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| 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 |
$2,078.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,874.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
REMOVAL OF DNETAL IMPLANT SUPER
|
Facility
|
IP
|
$4,157.25
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
30105785
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,874.89
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
OP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 31200
|
| Hospital Charge Code |
40109056
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$11,018.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,772.21
|
| Rate for Payer: Aetna Government |
$6,772.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,740.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,740.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,740.55
|
| Rate for Payer: Brighton Health Commercial |
$11,018.29
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Cash Price |
$6,772.21
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,772.21
|
| 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 |
$6,772.21
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,756.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,027.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,772.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,027.27
|
| Rate for Payer: Group Health Inc Commercial |
$6,772.21
|
| Rate for Payer: Group Health Inc Medicare |
$6,772.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,345.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,772.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,756.38
|
| Rate for Payer: Healthfirst QHP |
$6,772.21
|
| Rate for Payer: Humana Medicare |
$6,907.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,772.21
|
| Rate for Payer: United Healthcare Commercial |
$2,683.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,772.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,772.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,417.77
|
| Rate for Payer: Wellcare Medicare |
$6,433.60
|
|
|
REMOVAL OF ETHMOID SINUS
|
Facility
|
IP
|
$14,691.05
|
|
|
Service Code
|
HCPCS 31200
|
| Hospital Charge Code |
40109056
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,772.21
|
|
|
REMOVAL OF EXOSTOSIS - PER SITE
|
Facility
|
OP
|
$1,169.00
|
|
|
Service Code
|
HCPCS D7471
|
| Hospital Charge Code |
42303330
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$272.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$642.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$272.80
|
| Rate for Payer: Aetna Government |
$272.80
|
| Rate for Payer: Brighton Health Commercial |
$876.75
|
| 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 |
$584.50
|
| Rate for Payer: Group Health Inc Medicare |
$409.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$584.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$584.50
|
|
|
REMOVAL OF EYE LESION
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 65426
|
| Hospital Charge Code |
40074218
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$251,793.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5,665.34
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5,665.34
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,517.93
|
| Rate for Payer: Amida Care Medicaid |
$2,517.93
|
| Rate for Payer: Brighton Health Commercial |
$4,395.92
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$251,793.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,517.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,517.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,643.83
|
| Rate for Payer: Group Health Inc Commercial |
$2,702.32
|
| Rate for Payer: Group Health Inc Medicare |
$2,702.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,517.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,517.93
|
| Rate for Payer: Healthfirst Essential Plan |
$5,665.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,517.93
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2,517.93
|
| Rate for Payer: SOMOS Essential |
$5,665.34
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$5,665.34
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$2,769.72
|
| Rate for Payer: United Healthcare Medicaid |
$2,517.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
REMOVAL OF EYE LESION
|
Facility
|
OP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 65420
|
| Hospital Charge Code |
30301131
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,930.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,702.32
|
| Rate for Payer: Aetna Government |
$2,702.32
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,891.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,891.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,891.62
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Cash Price |
$2,702.32
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,702.32
|
| 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 |
$2,702.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,296.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,405.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,702.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,405.06
|
| 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 |
$2,930.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,702.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,296.97
|
| Rate for Payer: Healthfirst QHP |
$2,702.32
|
| Rate for Payer: Humana Medicare |
$2,756.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,702.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,702.32
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,702.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,702.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,161.86
|
| Rate for Payer: Wellcare Medicare |
$2,567.20
|
|
|
REMOVAL OF EYE LESION
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 65420
|
| Hospital Charge Code |
30301131
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
|
REMOVAL OF EYE LESION
|
Facility
|
IP
|
$5,861.23
|
|
|
Service Code
|
HCPCS 65426
|
| Hospital Charge Code |
40074218
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$2,702.32
|
|
|
REMOVAL OF FALLOPIAN TUBE
|
Facility
|
OP
|
$1,845.15
|
|
|
Service Code
|
HCPCS 58700
|
| Hospital Charge Code |
40059953
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$645.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,014.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$980.04
|
| Rate for Payer: Aetna Government |
$980.04
|
| Rate for Payer: Brighton Health Commercial |
$1,383.86
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$922.58
|
| Rate for Payer: Group Health Inc Medicare |
$645.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$922.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$922.58
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
Removal of fecal impaction or foreign body (separate procedure) under anesthesia
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$955.26 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,364.66
|
| Rate for Payer: Aetna Government |
$1,364.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$955.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$955.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$955.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,364.66
|
| 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 |
$1,364.66
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,159.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,214.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,364.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,214.55
|
| Rate for Payer: Group Health Inc Commercial |
$1,364.66
|
| Rate for Payer: Group Health Inc Medicare |
$1,364.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,364.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,159.96
|
| Rate for Payer: Healthfirst QHP |
$1,364.66
|
| Rate for Payer: Humana Medicare |
$1,391.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,364.66
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,364.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,364.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,091.73
|
| Rate for Payer: Wellcare Medicare |
$1,296.43
|
|
|
REMOVAL OF FIXATION DEVICE TONGS/
|
Facility
|
IP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
40009448
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$460.76
|
|
|
REMOVAL OF FIXATION DEVICE TONGS/
|
Facility
|
OP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 20665
|
| Hospital Charge Code |
40009448
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.53 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.76
|
| Rate for Payer: Aetna Government |
$460.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.53
|
| Rate for Payer: Brighton Health Commercial |
$825.92
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.76
|
| 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 |
$460.76
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.08
|
| Rate for Payer: Group Health Inc Commercial |
$460.76
|
| Rate for Payer: Group Health Inc Medicare |
$460.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.65
|
| Rate for Payer: Healthfirst QHP |
$460.76
|
| Rate for Payer: Humana Medicare |
$469.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.76
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.61
|
| Rate for Payer: Wellcare Medicare |
$437.72
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$1,823.17
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
30305501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$911.58
|
| 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
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$1,823.17
|
|
|
Service Code
|
HCPCS 28190
|
| Hospital Charge Code |
30305501
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$813.63
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
30106636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,858.61
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| 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 |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,858.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
30106636
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
IP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
40084209
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,858.61
|
|
|
REMOVAL OF FOOT LESION
|
Facility
|
OP
|
$4,105.13
|
|
|
Service Code
|
HCPCS 28080
|
| Hospital Charge Code |
40084209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,301.03 |
| Max. Negotiated Rate |
$3,078.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,858.61
|
| Rate for Payer: Aetna Government |
$1,858.61
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,301.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,301.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,301.03
|
| Rate for Payer: Brighton Health Commercial |
$3,078.85
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Cash Price |
$1,858.61
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,858.61
|
| 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 |
$1,858.61
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,579.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,654.16
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,858.61
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,654.16
|
| Rate for Payer: Group Health Inc Commercial |
$1,858.61
|
| Rate for Payer: Group Health Inc Medicare |
$1,858.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,858.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,579.82
|
| Rate for Payer: Healthfirst QHP |
$1,858.61
|
| Rate for Payer: Humana Medicare |
$1,895.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,858.61
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,858.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,858.61
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,486.89
|
| Rate for Payer: Wellcare Medicare |
$1,765.68
|
|
|
REMOVAL OF FOREIGN BODY EYE
|
Facility
|
OP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
30103046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$460.76
|
| Rate for Payer: Aetna Government |
$460.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.53
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.53
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.53
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$460.76
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Cash Price |
$460.76
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$460.76
|
| 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 |
$460.76
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.08
|
| Rate for Payer: Fidelis Medicare Advantage |
$460.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.08
|
| 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 |
$550.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$460.76
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$460.76
|
| Rate for Payer: Humana Medicare |
$469.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$460.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$460.76
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$460.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.61
|
| Rate for Payer: Wellcare Medicare |
$437.72
|
|
|
REMOVAL OF FOREIGN BODY EYE
|
Facility
|
IP
|
$1,101.23
|
|
|
Service Code
|
HCPCS 65220
|
| Hospital Charge Code |
30103046
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$460.76
|
|
|
Removal of foreign body in muscle or tendon sheath; deep or complicated
|
Facility
|
OP
|
$3,351.68
|
|
|
Service Code
|
CPT 20525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$3,351.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,285.96
|
| Rate for Payer: Aetna Government |
$3,285.96
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,300.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,300.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,300.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,285.96
|
| 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 |
$3,285.96
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,793.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,924.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,285.96
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,924.50
|
| Rate for Payer: Group Health Inc Commercial |
$3,285.96
|
| Rate for Payer: Group Health Inc Medicare |
$3,285.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,285.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,793.07
|
| Rate for Payer: Healthfirst QHP |
$3,285.96
|
| Rate for Payer: Humana Medicare |
$3,351.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,285.96
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,285.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,285.96
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,628.77
|
| Rate for Payer: Wellcare Medicare |
$3,121.66
|
|
|
REMOVAL OF FOREIGN BODY MOUTH
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 40804
|
| Hospital Charge Code |
40014116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$1,785.26
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
