|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,PREP,SCRN,INT
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 88161 TC
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,PREP,SCRN,INT
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 88161 TC
|
| Hospital Charge Code |
3118816101
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$69.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.19
|
| Rate for Payer: Aetna Government |
$25.19
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.10
|
| Rate for Payer: EmblemHealth Commercial |
$69.55
|
| Rate for Payer: Group Health Inc Commercial |
$34.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.31
|
| Rate for Payer: Healthfirst Essential Plan |
$43.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.31
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 88160 TC
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$68.39 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.29
|
| Rate for Payer: Aetna Government |
$29.29
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.40
|
| Rate for Payer: EmblemHealth Commercial |
$68.39
|
| Rate for Payer: Group Health Inc Commercial |
$34.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.31
|
| Rate for Payer: Healthfirst Essential Plan |
$43.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.31
|
|
|
HC CYTOPATH SMEAR OTHER SOURCE - LAB CYTOPATH,OTHR SOURC,SCREEN,INTERP
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 88160 TC
|
| Hospital Charge Code |
3118816001
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC CYTP DX EVAL FNA 1ST EA SITE - LAB EVALUATION OF FNA SMEAR, FIRST
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 88172 TC
|
| Hospital Charge Code |
3118817201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC CYTP DX EVAL FNA 1ST EA SITE - LAB EVALUATION OF FNA SMEAR, FIRST
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 88172 TC
|
| Hospital Charge Code |
3118817201
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.88
|
| Rate for Payer: Aetna Government |
$12.88
|
| Rate for Payer: Brighton Health Commercial |
$325.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21.06
|
| Rate for Payer: EmblemHealth Commercial |
$25.85
|
| Rate for Payer: Group Health Inc Commercial |
$217.00
|
| Rate for Payer: Group Health Inc Medicare |
$151.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$217.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.85
|
|
|
HC CYTP FNA EVAL EA ADDL - LAB EVALUATION OF FNA SMEAR, EA ADD EVAL
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 88177 TC
|
| Hospital Charge Code |
3118817701
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.50
|
|
|
HC CYTP FNA EVAL EA ADDL - LAB EVALUATION OF FNA SMEAR, EA ADD EVAL
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 88177 TC
|
| Hospital Charge Code |
3118817701
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$162.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$119.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.79
|
| Rate for Payer: Aetna Government |
$4.79
|
| Rate for Payer: Brighton Health Commercial |
$162.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.56
|
| Rate for Payer: EmblemHealth Commercial |
$10.09
|
| Rate for Payer: Group Health Inc Commercial |
$108.50
|
| Rate for Payer: Group Health Inc Medicare |
$75.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$108.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$10.09
|
|
|
HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
3611101002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.06 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$1,385.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| 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 |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| Rate for Payer: Group Health Inc Commercial |
$859.66
|
| Rate for Payer: Group Health Inc Medicare |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$322.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
|
HC DEBRIDE ASSOC OPEN FX/DISLOC SKIN/SUBQ
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
3611101002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE
|
Facility
|
IP
|
$7,747.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
3611101202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,873.50 |
| Max. Negotiated Rate |
$3,873.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,873.50
|
|
|
HC DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE
|
Facility
|
OP
|
$7,747.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
3611101202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.16 |
| Max. Negotiated Rate |
$5,810.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,496.91
|
| Rate for Payer: Aetna Government |
$3,496.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,447.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,447.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,447.84
|
| Rate for Payer: Brighton Health Commercial |
$5,810.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,496.91
|
| 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 |
$3,496.91
|
| Rate for Payer: EmblemHealth Commercial |
$3,496.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,147.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,972.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,112.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,496.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,112.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,496.91
|
| Rate for Payer: Group Health Inc Medicare |
$3,496.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,496.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$484.16
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,972.37
|
| Rate for Payer: Healthfirst QHP |
$3,496.91
|
| Rate for Payer: Humana Medicare |
$3,566.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,496.91
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,496.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,496.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,322.06
|
| Rate for Payer: Wellcare Medicare |
$3,322.06
|
|
|
HC DEBRIDE BONE ADD'L 20SQCM (ADDON)
|
Facility
|
IP
|
$2,494.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
3611104701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,247.00 |
| Max. Negotiated Rate |
$1,247.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,247.00
|
|
|
HC DEBRIDE BONE ADD'L 20SQCM (ADDON)
|
Facility
|
OP
|
$2,494.00
|
|
|
Service Code
|
CPT 11047
|
| Hospital Charge Code |
3611104701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.45 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$87.45
|
| Rate for Payer: Aetna Government |
$87.45
|
| Rate for Payer: Brighton Health Commercial |
$1,870.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,247.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,247.00
|
| Rate for Payer: Group Health Inc Medicare |
$872.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,247.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,247.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.37
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DEBRIDE BONE FIRST 20SQCM
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
3611104401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC DEBRIDE BONE FIRST 20SQCM
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
3611104401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| 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 |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$258.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC DEBRIDE INFECTED SKIN, EXTENSIVE, <10% BODY SURFACE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
3611100001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$36.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.35
|
| 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 DEBRIDE INFECTED SKIN, EXTENSIVE, <10% BODY SURFACE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
3611100001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC DEBRIDE MASTOID CAVITY - COMPLEX
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
5106922201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC DEBRIDE MASTOID CAVITY - COMPLEX
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 69222
|
| Hospital Charge Code |
5106922201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.29 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| 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 |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$154.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$158.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
3611100002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC DEBRIDEMENT, INFECTED SKIN, UP TO 10% BSA
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
3611100002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$36.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29.35
|
| 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 DEBRIDEMENT NAIL, 1-5
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
3611172001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC DEBRIDEMENT NAIL, 1-5
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
3611172001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC DEBRIDEMENT NAIL, 6 OR MORE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 11721
|
| Hospital Charge Code |
3611172101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$124.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
