|
HC ARTERIAL PUNCTURE
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
3613660001
|
|
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 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 20605 TC
|
| Hospital Charge Code |
3612060501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Government |
$49.88
|
| Rate for Payer: Brighton Health Commercial |
$589.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$393.00
|
| Rate for Payer: Group Health Inc Commercial |
$393.00
|
| Rate for Payer: Group Health Inc Medicare |
$275.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 20605 TC
|
| Hospital Charge Code |
3612060502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
|
OP
|
$786.00
|
|
|
Service Code
|
CPT 20605 TC
|
| Hospital Charge Code |
3612060502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.79 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Government |
$49.88
|
| Rate for Payer: Brighton Health Commercial |
$589.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$393.00
|
| Rate for Payer: Group Health Inc Commercial |
$393.00
|
| Rate for Payer: Group Health Inc Medicare |
$275.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US
|
Facility
|
IP
|
$786.00
|
|
|
Service Code
|
CPT 20605 TC
|
| Hospital Charge Code |
3612060501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$393.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
3612060601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$946.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.50
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
3612060602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$1,419.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| 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 |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$846.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| Rate for Payer: Group Health Inc Commercial |
$846.13
|
| Rate for Payer: Group Health Inc Medicare |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
3612060601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.78 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$1,419.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| 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 |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$846.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| Rate for Payer: Group Health Inc Commercial |
$846.13
|
| Rate for Payer: Group Health Inc Medicare |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$50.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
3612060602
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$946.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.50
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
3612061002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.64
|
| Rate for Payer: Aetna Government |
$46.64
|
| Rate for Payer: Brighton Health Commercial |
$921.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$614.50
|
| Rate for Payer: Group Health Inc Commercial |
$614.50
|
| Rate for Payer: Group Health Inc Medicare |
$430.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
OP
|
$1,229.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
3612061001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46.64
|
| Rate for Payer: Aetna Government |
$46.64
|
| Rate for Payer: Brighton Health Commercial |
$921.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$614.50
|
| Rate for Payer: Group Health Inc Commercial |
$614.50
|
| Rate for Payer: Group Health Inc Medicare |
$430.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
3612061002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.50 |
| Max. Negotiated Rate |
$614.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.50
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US
|
Facility
|
IP
|
$1,229.00
|
|
|
Service Code
|
CPT 20610 TC
|
| Hospital Charge Code |
3612061001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$614.50 |
| Max. Negotiated Rate |
$614.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$614.50
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
3612061102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
3612061101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
3612061102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
3612061101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$67.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3612060001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3612060001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3612060002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
3612060002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
3612060401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC ARTHROGRAM OF ANKLE - XR ANKLE ARTHROGRAM
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 73615 TC
|
| Hospital Charge Code |
3207361501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$635.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.28
|
| Rate for Payer: Aetna Government |
$59.28
|
| Rate for Payer: Brighton Health Commercial |
$867.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$588.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$495.42
|
| Rate for Payer: EmblemHealth Commercial |
$102.21
|
| Rate for Payer: Group Health Inc Commercial |
$578.00
|
| Rate for Payer: Group Health Inc Medicare |
$404.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$578.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$102.21
|
| Rate for Payer: Healthfirst Essential Plan |
$190.80
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$84.80
|
|
|
HC ARTHROGRAM OF ANKLE - XR ANKLE ARTHROGRAM
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 73615 TC
|
| Hospital Charge Code |
3207361501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$578.00 |
| Max. Negotiated Rate |
$578.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$578.00
|
|
