|
HC CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3615415001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,502.91
|
| Rate for Payer: Aetna Government |
$2,502.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,752.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,752.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,752.04
|
| Rate for Payer: Brighton Health Commercial |
$1,090.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,502.91
|
| 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 |
$2,502.91
|
| Rate for Payer: EmblemHealth Commercial |
$2,502.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,252.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,127.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,227.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,502.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,227.59
|
| Rate for Payer: Group Health Inc Commercial |
$2,502.91
|
| Rate for Payer: Group Health Inc Medicare |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$108.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,127.47
|
| Rate for Payer: Healthfirst QHP |
$2,502.91
|
| Rate for Payer: Humana Medicare |
$2,552.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,502.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,502.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,377.76
|
| Rate for Payer: Wellcare Medicare |
$2,377.76
|
|
|
HC CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
3615415001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.00 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.00
|
|
|
HC CK-ISOENZYME ELECTROPHORESIS
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 82552
|
| Hospital Charge Code |
3018255201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC CK-ISOENZYME ELECTROPHORESIS
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 82552
|
| Hospital Charge Code |
3018255201
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.39
|
| Rate for Payer: Aetna Government |
$13.39
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.37
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.39
|
| Rate for Payer: EmblemHealth Commercial |
$13.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.92
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.92
|
| Rate for Payer: Group Health Inc Commercial |
$13.39
|
| Rate for Payer: Group Health Inc Medicare |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.39
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Healthfirst Essential Plan |
$21.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.39
|
| Rate for Payer: Healthfirst QHP |
$13.39
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$16.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.49
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
|
|
HC CLD TX OF FEM FRAC, PROX END HEAD W/MANIP
|
Facility
|
OP
|
$1,395.00
|
|
|
Service Code
|
CPT 27268
|
| Hospital Charge Code |
3612726801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.25 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$767.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$546.88
|
| Rate for Payer: Aetna Government |
$546.88
|
| Rate for Payer: Brighton Health Commercial |
$1,046.25
|
| 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 |
$697.50
|
| Rate for Payer: Group Health Inc Commercial |
$697.50
|
| Rate for Payer: Group Health Inc Medicare |
$488.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$697.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$655.60
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC CLD TX OF FEM FRAC, PROX END HEAD W/MANIP
|
Facility
|
IP
|
$1,395.00
|
|
|
Service Code
|
CPT 27268
|
| Hospital Charge Code |
3612726801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$697.50 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$697.50
|
|
|
HC CLD TX POST HIP ARTHRPY DISCTN W/ANES
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
3612726601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$695.77 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,955.41
|
| Rate for Payer: Aetna Government |
$1,955.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,368.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,368.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,368.79
|
| Rate for Payer: Brighton Health Commercial |
$3,078.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,955.41
|
| 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 |
$1,955.41
|
| Rate for Payer: EmblemHealth Commercial |
$1,955.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,759.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,662.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,740.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,955.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,740.31
|
| Rate for Payer: Group Health Inc Commercial |
$1,955.41
|
| Rate for Payer: Group Health Inc Medicare |
$1,955.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,955.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$695.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,662.10
|
| Rate for Payer: Healthfirst QHP |
$1,955.41
|
| Rate for Payer: Humana Medicare |
$1,994.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,955.41
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,955.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,955.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,857.64
|
| Rate for Payer: Wellcare Medicare |
$1,857.64
|
|
|
HC CLD TX POST HIP ARTHRPY DISCTN W/ANES
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
3612726601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,052.50 |
| Max. Negotiated Rate |
$2,052.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.50
|
|
|
HC CLD TX POST HIP ARTHRPY DISCTN W/O ANES
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
3612726501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$489.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$507.41
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC CLD TX POST HIP ARTHRPY DISCTN W/O ANES
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
3612726501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC CLEARANCE OF TEAR DUCT
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 68530
|
| Hospital Charge Code |
5106853001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$160.11 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| 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 |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$283.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC CLEARANCE OF TEAR DUCT
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 68530
|
| Hospital Charge Code |
5106853001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC CLINICAL CHEMISTRY TEST - FECAL ANALYSIS
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3018499902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC CLINICAL CHEMISTRY TEST - FECAL ANALYSIS
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3018499902
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.00
|
| Rate for Payer: Aetna Government |
$83.00
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.65
|
| Rate for Payer: EmblemHealth Commercial |
$83.00
|
| Rate for Payer: Group Health Inc Commercial |
$83.00
|
| Rate for Payer: Group Health Inc Medicare |
$58.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.00
|
|
|
HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3018499901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3018499901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.00
|
| Rate for Payer: Aetna Government |
$83.00
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.65
|
| Rate for Payer: EmblemHealth Commercial |
$83.00
|
| Rate for Payer: Group Health Inc Commercial |
$83.00
|
| Rate for Payer: Group Health Inc Medicare |
$58.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.00
|
|
|
HC CLINICAL CHEMISTRY TEST - POTASSIUM, FECAL
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3018499903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$124.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$91.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$83.00
|
| Rate for Payer: Aetna Government |
$83.00
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.65
|
| Rate for Payer: EmblemHealth Commercial |
$83.00
|
| Rate for Payer: Group Health Inc Commercial |
$83.00
|
| Rate for Payer: Group Health Inc Medicare |
$58.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$83.00
|
|
|
HC CLINICAL CHEMISTRY TEST - POTASSIUM, FECAL
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 84999
|
| Hospital Charge Code |
3018499903
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC CLOSED REDUCTN METACARPAL FRACTURE
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
3612660001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$491.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$355.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC CLOSED REDUCTN METACARPAL FRACTURE
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
3612660001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$327.50 |
| Max. Negotiated Rate |
$327.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$327.50
|
|
|
HC CLOSED RX ACETABULAR FX
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
3612722001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.00
|
|
|
HC CLOSED RX ACETABULAR FX
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 27220
|
| Hospital Charge Code |
3612722001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$465.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$495.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC CLOSED RX ANKLE DISLOCATN
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
3612784001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC CLOSED RX ANKLE DISLOCATN
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
3612784002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$293.09
|
| Rate for Payer: Aetna Government |
$293.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$205.16
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$205.16
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$205.16
|
| Rate for Payer: Brighton Health Commercial |
$489.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$293.09
|
| 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 |
$293.09
|
| Rate for Payer: EmblemHealth Commercial |
$293.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$263.78
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$249.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$260.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$293.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$260.85
|
| Rate for Payer: Group Health Inc Commercial |
$293.09
|
| Rate for Payer: Group Health Inc Medicare |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$470.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$249.13
|
| Rate for Payer: Healthfirst QHP |
$293.09
|
| Rate for Payer: Humana Medicare |
$298.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$293.09
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$293.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$293.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$278.44
|
| Rate for Payer: Wellcare Medicare |
$278.44
|
|
|
HC CLOSED RX ANKLE DISLOCATN
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
3612784002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
