|
HC CLOSED TRMT METACARP FRAC W/MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
3612660501
|
|
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 TRMT METACARP FRAC W/MANIP
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
3612660501
|
|
Hospital Revenue Code
|
361
|
| 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 |
$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 |
$365.82
|
| 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 TRMT METACARP FRAC W/MANIP, W/EXT FIXN
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
3612660701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$607.20 |
| Max. Negotiated Rate |
$6,218.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,964.33
|
| Rate for Payer: Aetna Government |
$3,964.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,775.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,775.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,775.03
|
| Rate for Payer: Brighton Health Commercial |
$6,218.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,964.33
|
| 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 |
$3,964.33
|
| Rate for Payer: EmblemHealth Commercial |
$3,964.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,567.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,369.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,528.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,964.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,528.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,964.33
|
| Rate for Payer: Group Health Inc Medicare |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,579.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$607.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,369.68
|
| Rate for Payer: Healthfirst QHP |
$3,964.33
|
| Rate for Payer: Humana Medicare |
$4,043.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,964.33
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,964.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,964.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,766.11
|
| Rate for Payer: Wellcare Medicare |
$3,766.11
|
|
|
HC CLOSED TRMT METACARP FRAC W/MANIP, W/EXT FIXN
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
3612660701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,145.50 |
| Max. Negotiated Rate |
$4,145.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.50
|
|
|
HC CLOSED TX CARPAL BONE FRAC W/MANIP
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
3612563501
|
|
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 TX CARPAL BONE FRAC W/MANIP
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
3612563501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$518.51 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$3,078.75
|
| 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 |
$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 TX CARPAL BONE FRAC W/O MANIP
|
Facility
|
IP
|
$645.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
3612563001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.50 |
| Max. Negotiated Rate |
$322.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$322.50
|
|
|
HC CLOSED TX CARPAL BONE FRAC W/O MANIP
|
Facility
|
OP
|
$645.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
3612563001
|
|
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 |
$483.75
|
| 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 |
$351.23
|
| 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 TX FX GREAT TOE PHALANX W/MANIPULATION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
3612849501
|
|
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 TX FX GREAT TOE PHALANX W/MANIPULATION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
3612849501
|
|
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 TX FX GREAT TOE PHALANX W/O MANIPULATION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
3612849001
|
|
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 TX FX GREAT TOE PHALANX W/O MANIPULATION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
3612849001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.24 |
| 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 |
$101.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.12
|
| 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 TX MANDIBULAR FRAC W/MANIP
|
Facility
|
OP
|
$4,086.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
3612145101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$3,064.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| 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 |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$1,809.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,809.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$736.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC CLOSED TX MANDIBULAR FRAC W/MANIP
|
Facility
|
IP
|
$4,086.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
3612145101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.00
|
|
|
HC CLOSED TX METATARSAL FRACTURE, W/MANIPULATION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
3612847501
|
|
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 TX METATARSAL FRACTURE, W/MANIPULATION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
3612847501
|
|
Hospital Revenue Code
|
761
|
| 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 |
$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 |
$128.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$272.74
|
| 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 TX METATARSAL FRACTURE, W/O MANIPULATION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
3612847001
|
|
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 |
$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 |
$247.16
|
| 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 TX METATARSAL FRACTURE, W/O MANIPULATION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
3612847001
|
|
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 TX OF BIMALLEOLAR FRACTURE, W/MANIP
|
Facility
|
IP
|
$4,057.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
3612781001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,028.50 |
| Max. Negotiated Rate |
$2,028.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,028.50
|
|
|
HC CLOSED TX OF BIMALLEOLAR FRACTURE, W/MANIP
|
Facility
|
OP
|
$4,057.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
3612781001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$519.96 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$3,042.75
|
| 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 |
$519.96
|
| 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 TX OF BIMALLEOLAR FRACTURE, W/O MANIP
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
3612780801
|
|
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 |
$375.46
|
| 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 TX OF BIMALLEOLAR FRACTURE, W/O MANIP
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
3612780801
|
|
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 TX OF TALUS FRACTURE W/O MANIPULATION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
3612843001
|
|
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 TX OF TALUS FRACTURE W/O MANIPULATION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
3612843001
|
|
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 |
$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 |
$255.55
|
| 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 TX TALOTARSAL JOINT DISLOCATION, W/O ANES
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
3612857001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$494.25
|
| 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 |
$244.43
|
| 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
|
|
