|
HC ANTITHROMBIN III TEST,ACTIV - ANTITHROMBIN PANEL
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
3058530002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$14.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.50
|
|
|
HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
3058530101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
|
|
HC ANTITHROMBIN III TEST,ANTIGEN - ANTITHROMBIN III AG
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
3058530101
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.81
|
| Rate for Payer: Aetna Government |
$10.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7.57
|
| Rate for Payer: Brighton Health Commercial |
$20.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.47
|
| Rate for Payer: Elderplan Medicare Advantage |
$10.81
|
| Rate for Payer: EmblemHealth Commercial |
$10.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.19
|
| Rate for Payer: Fidelis Essential Plan QHP |
$9.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$10.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$9.62
|
| Rate for Payer: Group Health Inc Commercial |
$10.81
|
| Rate for Payer: Group Health Inc Medicare |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.81
|
| Rate for Payer: Healthfirst Essential Plan |
$24.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10.81
|
| Rate for Payer: Healthfirst QHP |
$10.81
|
| Rate for Payer: Humana Medicare |
$11.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10.81
|
| Rate for Payer: United Healthcare Commercial |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.81
|
| Rate for Payer: Wellcare Medicare |
$9.73
|
|
|
HC APC (ADENOMATOUS POLYPOSIS COLI) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 81203
|
| Hospital Charge Code |
3108120301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.50
|
|
|
HC APC (ADENOMATOUS POLYPOSIS COLI) GENE ANALYSIS; DUPLICATION/DELETION VARIANTS
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 81203
|
| Hospital Charge Code |
3108120301
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$200.00
|
| Rate for Payer: Aetna Government |
$200.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$140.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$140.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$140.00
|
| Rate for Payer: Brighton Health Commercial |
$200.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$200.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$200.00
|
| Rate for Payer: EmblemHealth Commercial |
$200.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$180.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$170.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$178.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$200.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$178.00
|
| Rate for Payer: Group Health Inc Commercial |
$200.00
|
| Rate for Payer: Group Health Inc Medicare |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$200.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$200.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$200.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$200.00
|
| Rate for Payer: Healthfirst QHP |
$200.00
|
| Rate for Payer: Humana Medicare |
$204.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$200.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$200.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$200.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$190.00
|
| Rate for Payer: Wellcare Medicare |
$180.00
|
|
|
HC APC (ADENOMATOUS POLYPOSIS COLI) GENE ANALYSIS; FULL GENE SEQUENCE
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 81201
|
| Hospital Charge Code |
3108120101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$780.00
|
| Rate for Payer: Aetna Government |
$780.00
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$546.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$546.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$546.00
|
| Rate for Payer: Brighton Health Commercial |
$780.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$780.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$103.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$87.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$780.00
|
| Rate for Payer: EmblemHealth Commercial |
$780.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$702.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$663.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$694.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$780.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$694.20
|
| Rate for Payer: Group Health Inc Commercial |
$780.00
|
| Rate for Payer: Group Health Inc Medicare |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$780.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$780.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$780.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$780.00
|
| Rate for Payer: Healthfirst QHP |
$780.00
|
| Rate for Payer: Humana Medicare |
$795.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$780.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$780.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$780.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$741.00
|
| Rate for Payer: Wellcare Medicare |
$702.00
|
|
|
HC APC (ADENOMATOUS POLYPOSIS COLI) GENE ANALYSIS; FULL GENE SEQUENCE
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 81201
|
| Hospital Charge Code |
3108120101
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$64.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$64.50
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
636Q410101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
|
|
HC APLIGRAF PER SQ CM
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
636Q410101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$30.43
|
| Rate for Payer: Aetna Government |
$30.43
|
| Rate for Payer: Brighton Health Commercial |
$42.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$35.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40.83
|
| Rate for Payer: EmblemHealth Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Commercial |
$35.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46.15
|
|
|
HC APPLICATION OF FINGER SPLINT DYNAMIC
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
5102913101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| 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 |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC APPLICATION OF FINGER SPLINT DYNAMIC
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 29131
|
| Hospital Charge Code |
5102913101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC APPLICATION OF LEG CAST
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
5102945001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.57 |
| 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 |
$68.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$126.17
|
| 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 APPLICATION OF LEG CAST
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 29450
|
| Hospital Charge Code |
5102945001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$213.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$213.50
|
|
|
HC APPLICATION OF LONG LEG SPLINT - PT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
4202950501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.00 |
| 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 |
$182.00
|
| 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 |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$192.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.79
|
| 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 |
$192.79
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$62.47
|
| 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: 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 |
$55.00
|
|
|
HC APPLICATION OF LONG LEG SPLINT - PT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
4202950501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
2609637701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$57.50 |
| Max. Negotiated Rate |
$57.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.50
|
|
|
HC APPLICATION ON-BODY INJECTOR
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 96377
|
| Hospital Charge Code |
2609637701
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$20.45 |
| 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 |
$20.45
|
| 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 APPLICATION SHORT LEG SPLINT - PT
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
4202951501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APPLICATION SHORT LEG SPLINT - PT
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
4202951501
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.61 |
| 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 |
$182.00
|
| 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 |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$192.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$192.79
|
| 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 |
$192.79
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.61
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$58.57
|
| 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: 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 |
$55.00
|
|
|
HC APPLICATN UNIPLANE, UNI, EXT FIXATN SYSTEM
|
Facility
|
OP
|
$17,690.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
3612069001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$13,267.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8,728.35
|
| Rate for Payer: Aetna Government |
$8,728.35
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6,109.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6,109.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6,109.85
|
| Rate for Payer: Brighton Health Commercial |
$13,267.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8,728.35
|
| 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 |
$8,728.35
|
| Rate for Payer: EmblemHealth Commercial |
$8,728.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7,855.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7,419.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7,768.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$8,728.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7,768.23
|
| Rate for Payer: Group Health Inc Commercial |
$8,728.35
|
| Rate for Payer: Group Health Inc Medicare |
$8,728.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,728.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,924.84
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$708.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,419.10
|
| Rate for Payer: Healthfirst QHP |
$8,728.35
|
| Rate for Payer: Humana Medicare |
$8,902.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8,728.35
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,728.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8,728.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8,291.93
|
| Rate for Payer: Wellcare Medicare |
$8,291.93
|
|
|
HC APPLICATN UNIPLANE, UNI, EXT FIXATN SYSTEM
|
Facility
|
IP
|
$17,690.00
|
|
|
Service Code
|
CPT 20690
|
| Hospital Charge Code |
3612069001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,845.00 |
| Max. Negotiated Rate |
$8,845.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8,845.00
|
|
|
HC APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
3612958101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$303.75
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$192.79
|
| 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 |
$192.79
|
| Rate for Payer: Group Health Inc Medicare |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$64.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.27
|
| 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: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
3612958101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, 1ST 25 SQCM
|
Facility
|
IP
|
$1,390.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
361C527501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.00 |
| Max. Negotiated Rate |
$695.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$695.00
|
|
|
HC APP LOW COST SKIN GFT, FACE/SCALP/GEN/HND/FT, 1ST 25 SQCM
|
Facility
|
OP
|
$1,390.00
|
|
|
Service Code
|
CPT C5275
|
| Hospital Charge Code |
361C527501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$1,113.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,042.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,112.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$945.20
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
