|
HC COMP WND REP, FACE/NECK/AXILLAE/GEN/HAND/FEET, 1.1-2.5CM
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
3611313101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC COMP WND REP, FACE/NECK/AXILLAE/GEN/HAND/FEET, 1.1-2.5CM
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
3611313101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.39 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| 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 |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$488.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| Rate for Payer: Group Health Inc Commercial |
$488.15
|
| Rate for Payer: Group Health Inc Medicare |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$214.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$277.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.93
|
| Rate for Payer: Healthfirst QHP |
$488.15
|
| Rate for Payer: Humana Medicare |
$497.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$488.15
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$488.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.74
|
| Rate for Payer: Wellcare Medicare |
$463.74
|
|
|
HC COMP WND REP, FACE/NECK/AXILLAE/GEN/HAND/FEET, 2.6-7.5CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
3611313201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$343.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, FACE/NECK/AXILLAE/GEN/HAND/FEET, 2.6-7.5CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
3611313201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC COMP WND REP, FACE/NECK/AXILLAE/GEN/HAND/FEET, 5CM/< (ADDON)
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
3611313301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.00
|
|
|
HC COMP WND REP, FACE/NECK/AXILLAE/GEN/HAND/FEET, 5CM/< (ADDON)
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
3611313301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$114.36 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.36
|
| Rate for Payer: Aetna Government |
$114.36
|
| Rate for Payer: Brighton Health Commercial |
$564.00
|
| 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 |
$376.00
|
| Rate for Payer: Group Health Inc Commercial |
$376.00
|
| Rate for Payer: Group Health Inc Medicare |
$263.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$141.66
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC COMP WND REP, SCALP/ARM/LEG, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
3611312001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.09 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$264.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, SCALP/ARM/LEG, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
3611312001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC COMP WND REP, SCALP/ARM/LEG, 2.6-7.5CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
3611312101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.62 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$294.62
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, SCALP/ARM/LEG, 2.6-7.5CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
3611312101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC COMP WND REP, SCALP/ARM/LEG, EACH ADD'L 5CM/< (ADDON)
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
3611312201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$114.77
|
| Rate for Payer: Aetna Government |
$114.77
|
| Rate for Payer: Brighton Health Commercial |
$564.00
|
| 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 |
$376.00
|
| Rate for Payer: Group Health Inc Commercial |
$376.00
|
| Rate for Payer: Group Health Inc Medicare |
$263.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$93.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC COMP WND REP, SCALP/ARM/LEG, EACH ADD'L 5CM/< (ADDON)
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
3611312201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.00
|
|
|
HC COMP WND REP, TRUNK, 1.1-2.5CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
3611310001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC COMP WND REP, TRUNK, 1.1-2.5CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
3611310001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$230.32 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$230.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, TRUNK, 2.6-7.5CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
3611310101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.84 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$281.84
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC COMP WND REP, TRUNK, 2.6-7.5CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
3611310101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC COMP WND REP, TRUNK, EACH ADD'L 5CM/< (ADDON)
|
Facility
|
OP
|
$752.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
3611310201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.30 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.30
|
| Rate for Payer: Aetna Government |
$65.30
|
| Rate for Payer: Brighton Health Commercial |
$564.00
|
| 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 |
$376.00
|
| Rate for Payer: Group Health Inc Commercial |
$376.00
|
| Rate for Payer: Group Health Inc Medicare |
$263.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$376.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$82.25
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC COMP WND REP, TRUNK, EACH ADD'L 5CM/< (ADDON)
|
Facility
|
IP
|
$752.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
3611310201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$376.00
|
|
|
HC CONCENTRATION FOR INFACTIOUS AGENT
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.00
|
|
|
HC CONCENTRATION FOR INFACTIOUS AGENT
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3068701501
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.68
|
| Rate for Payer: Aetna Government |
$6.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.68
|
| Rate for Payer: Brighton Health Commercial |
$12.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.68
|
| Rate for Payer: EmblemHealth Commercial |
$6.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.95
|
| Rate for Payer: Group Health Inc Commercial |
$6.68
|
| Rate for Payer: Group Health Inc Medicare |
$6.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.28
|
| Rate for Payer: Healthfirst Essential Plan |
$7.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.68
|
| Rate for Payer: Healthfirst QHP |
$6.68
|
| Rate for Payer: Humana Medicare |
$6.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.68
|
| Rate for Payer: United Healthcare Commercial |
$8.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3.28
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
|
|
HC CONDITIONING PLAY AUDIOMETRY
|
Facility
|
IP
|
$419.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
4719258201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$209.50 |
| Max. Negotiated Rate |
$209.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.50
|
|
|
HC CONDITIONING PLAY AUDIOMETRY
|
Facility
|
OP
|
$419.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
4719258201
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$104.26 |
| Max. Negotiated Rate |
$335.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$191.17
|
| Rate for Payer: Aetna Government |
$191.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$133.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$133.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$133.82
|
| Rate for Payer: Brighton Health Commercial |
$314.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$191.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$335.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$284.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$191.17
|
| Rate for Payer: EmblemHealth Commercial |
$191.17
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$172.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$162.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$170.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$191.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$170.14
|
| Rate for Payer: Group Health Inc Commercial |
$191.17
|
| Rate for Payer: Group Health Inc Medicare |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$191.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$162.49
|
| Rate for Payer: Healthfirst QHP |
$191.17
|
| Rate for Payer: Humana Medicare |
$194.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$191.17
|
| Rate for Payer: United Healthcare Commercial |
$158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$191.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$191.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$181.61
|
| Rate for Payer: Wellcare Medicare |
$181.61
|
|
|
HC CONIZATION CERVIX,KNIFE/LASER
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
3615752001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
|
HC CONIZATION CERVIX,KNIFE/LASER
|
Facility
|
OP
|
$8,480.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
3615752001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.88 |
| Max. Negotiated Rate |
$6,360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$6,360.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$346.88
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC CONIZATION CERVIX,LOOP ELECTRD
|
Facility
|
IP
|
$8,480.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
3615752201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,240.00
|
|
