|
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 BIG TOE FX,MANIP
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
3612849502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.27 |
| 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 |
$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 |
$122.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$179.24
|
| 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 BIG TOE FX,MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
3612849502
|
|
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 CARPAL FX,MAIPULATN
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
3612563502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX CARPAL FX,MAIPULATN
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
3612563502
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$518.51 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,226.50
|
| 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 |
$518.51
|
| 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 |
$1,113.00
|
| 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 CLOSED RX CLAVICLE FX,MANIPULATN
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
3612350501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX CLAVICLE FX,MANIPULATN
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
3612350501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$411.34 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,226.50
|
| 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 |
$411.34
|
| 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 |
$1,188.00
|
| 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 CLOSED RX CONDYLAR FX
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
7612750101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$599.34
|
| 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 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 CONDYLAR FX
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
7612750101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$310.00
|
|
|
HC CLOSED RX DIST FEM EPIPHYSIS+MANIP
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
7612751701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,226.50
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$830.42
|
| 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 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 CLOSED RX DIST FEM EPIPHYSIS+MANIP
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
7612751701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX DIST RAD/ULNA FX, W/MANIP
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
3612560501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$620.25 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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 |
$620.25
|
| 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 |
$1,188.00
|
| 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 CLOSED RX DIST RAD/ULNA FX, W/MANIP
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
3612560501
|
|
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 CLOSED RX FEMUR,DISTAL+MANIP
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
7612751001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,226.50
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$812.97
|
| 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 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 CLOSED RX FEMUR,DISTAL+MANIP
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
7612751001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX FEMUR SHAFT FX+MANIP
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
7612750201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| 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 |
$3,226.50
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$897.91
|
| 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 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 CLOSED RX FEMUR SHAFT FX+MANIP
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
7612750201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX HUMER CONDYLR FX,MANIP
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
7612457701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX HUMER CONDYLR FX,MANIP
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
7612457701
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,226.50
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$619.44
|
| 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 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 CLOSED RX HUMER EPICONDYLR FX,MANIP
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
7612456501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| 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 |
$3,226.50
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$602.54
|
| 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 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 CLOSED RX HUMER EPICONDYLR FX,MANIP
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
7612456501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC CLOSED RX I-P JT,TOE DISLOCATION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
7612866001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.98 |
| 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 |
$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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$293.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$111.88
|
| 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 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 I-P JT,TOE DISLOCATION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
7612866001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$326.50 |
| Max. Negotiated Rate |
$326.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.50
|
|
|
HC CLOSED RX KNEE DISLOC+ANESTH
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
7612755201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$3,226.50
|
| 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 |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$762.24
|
| 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 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 CLOSED RX KNEE DISLOC+ANESTH
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
7612755201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
