|
HC DECOMP FASCIOTOMY, FOREARM/WRIST, W/ DEBRIDEMENT
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 25025
|
| Hospital Charge Code |
3612502501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.29 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$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 |
$1,455.22
|
| 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 |
$1,468.00
|
| 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 DECOMPRESSION PROCEDURE, PERCUTANEOUS, NUCLEUS PULPOSUS INTERVERTRAL DISC
|
Facility
|
OP
|
$5,207.00
|
|
|
Service Code
|
CPT 62287 TC
|
| Hospital Charge Code |
3616228701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$655.26 |
| Max. Negotiated Rate |
$5,593.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$655.26
|
| Rate for Payer: Aetna Government |
$655.26
|
| Rate for Payer: Brighton Health Commercial |
$3,905.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,603.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,603.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,822.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.93
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC DECOMPRESSION PROCEDURE, PERCUTANEOUS, NUCLEUS PULPOSUS INTERVERTRAL DISC
|
Facility
|
IP
|
$5,207.00
|
|
|
Service Code
|
CPT 62287 TC
|
| Hospital Charge Code |
3616228701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,603.50 |
| Max. Negotiated Rate |
$2,603.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,603.50
|
|
|
HC DEEP MUSCLE BIOPSY
|
Facility
|
OP
|
$6,768.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
3612020501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$186.11 |
| Max. Negotiated Rate |
$5,076.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| 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 |
$5,076.00
|
| 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 |
$186.11
|
| 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 |
$1,409.00
|
| 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 DEEP MUSCLE BIOPSY
|
Facility
|
IP
|
$6,768.00
|
|
|
Service Code
|
CPT 20205
|
| Hospital Charge Code |
3612020501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,384.00 |
| Max. Negotiated Rate |
$3,384.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,384.00
|
|
|
HC DEEP SEDATION/GENERAL ANESTHESIA
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT D9222
|
| Hospital Charge Code |
361D922201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
|
|
HC DEEP SEDATION/GENERAL ANESTHESIA
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT D9222
|
| Hospital Charge Code |
361D922201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$735.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$52.36
|
| Rate for Payer: Aetna Government |
$52.36
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$735.62
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$735.62
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$326.94
|
| Rate for Payer: Amida Care Medicaid |
$326.94
|
| Rate for Payer: Brighton Health Commercial |
$142.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: EmblemHealth Commercial |
$95.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$735.62
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$326.94
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$326.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$735.62
|
| Rate for Payer: Fidelis Essential Plan QHP |
$735.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$343.29
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$326.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$326.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$326.94
|
| Rate for Payer: Healthfirst Essential Plan |
$735.62
|
| Rate for Payer: Healthfirst QHP |
$532.91
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$326.94
|
| Rate for Payer: SOMOS Essential |
$735.62
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$735.62
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$359.63
|
| Rate for Payer: United Healthcare Medicaid |
$326.94
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$326.94
|
|
|
HC DEHYDROEPIANDROSTERONE - DHEA
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
3018262601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.69 |
| Max. Negotiated Rate |
$54.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.27
|
| Rate for Payer: Aetna Government |
$25.27
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.69
|
| Rate for Payer: Brighton Health Commercial |
$41.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25.27
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$42.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$25.27
|
| Rate for Payer: EmblemHealth Commercial |
$25.27
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$21.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$22.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$25.27
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22.49
|
| Rate for Payer: Group Health Inc Commercial |
$25.27
|
| Rate for Payer: Group Health Inc Medicare |
$25.27
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.27
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.06
|
| Rate for Payer: Healthfirst Essential Plan |
$54.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25.27
|
| Rate for Payer: Healthfirst QHP |
$25.27
|
| Rate for Payer: Humana Medicare |
$25.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25.27
|
| Rate for Payer: United Healthcare Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25.27
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24.06
|
| Rate for Payer: Wellcare Medicare |
$22.74
|
|
|
HC DEHYDROEPIANDROSTERONE - DHEA
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82626
|
| Hospital Charge Code |
3018262601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
|
|
HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
3018262701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$50.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$30.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.23
|
| Rate for Payer: Aetna Government |
$22.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15.56
|
| Rate for Payer: Brighton Health Commercial |
$41.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31.81
|
| Rate for Payer: Elderplan Medicare Advantage |
$22.23
|
| Rate for Payer: EmblemHealth Commercial |
$22.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$22.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19.78
|
| Rate for Payer: Group Health Inc Commercial |
$22.23
|
| Rate for Payer: Group Health Inc Medicare |
$22.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22.23
|
| Rate for Payer: Healthfirst Essential Plan |
$50.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$22.23
|
| Rate for Payer: Healthfirst QHP |
$22.23
|
| Rate for Payer: Humana Medicare |
$22.67
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22.23
|
| Rate for Payer: United Healthcare Commercial |
$28.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22.23
|
| Rate for Payer: Wellcare Medicare |
$20.01
|
|
|
HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
3018262701
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$27.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27.50
|
|
|
HC DELIVER PLACENTA
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
3615941401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$3,962.51 |
| 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 |
$1,579.50
|
| 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 |
$110.44
|
| 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 DELIVER PLACENTA
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
3615941401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,053.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,053.00
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
5105941401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$4,079.05 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$110.44
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,079.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 DELIVERY OF PLACENTA
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
5105941401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC DENTAL SURGERY PROCEDURE
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
3614189901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.00
|
|
|
HC DENTAL SURGERY PROCEDURE
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
3614189901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.17 |
| Max. Negotiated Rate |
$3,538.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,538.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,538.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,572.87
|
| Rate for Payer: Amida Care Medicaid |
$1,572.87
|
| Rate for Payer: Brighton Health Commercial |
$732.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| 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 |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$283.73
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$3,538.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$1,572.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,572.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,538.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,538.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,651.50
|
| Rate for Payer: Group Health Inc Commercial |
$283.73
|
| Rate for Payer: Group Health Inc Medicare |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,572.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,572.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,538.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$2,563.77
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,572.87
|
| Rate for Payer: SOMOS Essential |
$3,538.97
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,538.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,730.13
|
| Rate for Payer: United Healthcare Medicaid |
$1,572.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,572.87
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC DENTAL SURGERY PROCEDURE-COSMETIC
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
3614189902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.17 |
| Max. Negotiated Rate |
$3,538.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,538.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,538.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,572.87
|
| Rate for Payer: Amida Care Medicaid |
$1,572.87
|
| Rate for Payer: Brighton Health Commercial |
$732.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| 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 |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$283.73
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$3,538.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$1,572.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,572.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,538.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,538.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,651.50
|
| Rate for Payer: Group Health Inc Commercial |
$283.73
|
| Rate for Payer: Group Health Inc Medicare |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,572.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$283.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,572.87
|
| Rate for Payer: Healthfirst Essential Plan |
$3,538.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$2,563.77
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1,572.87
|
| Rate for Payer: SOMOS Essential |
$3,538.97
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$3,538.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$1,730.13
|
| Rate for Payer: United Healthcare Medicaid |
$1,572.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,572.87
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC DENTAL SURGERY PROCEDURE-COSMETIC
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
3614189902
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.00
|
|
|
HC DEOXYRIBONUCLEASE, ANTIBODY - ANTI DNASE B ANTIBODY
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
3028621501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.50
|
|
|
HC DEOXYRIBONUCLEASE, ANTIBODY - ANTI DNASE B ANTIBODY
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
3028621501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$16.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
|
|
HC DERMAGRAFT PER 1 SQ CM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
636Q410601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.50 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.50
|
|
|
HC DERMAGRAFT PER 1 SQ CM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT Q4106
|
| Hospital Charge Code |
636Q410601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.35 |
| Max. Negotiated Rate |
$52.65 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$44.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32.03
|
| Rate for Payer: Aetna Government |
$32.03
|
| Rate for Payer: Brighton Health Commercial |
$48.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$46.58
|
| Rate for Payer: EmblemHealth Commercial |
$40.50
|
| Rate for Payer: Group Health Inc Commercial |
$40.50
|
| Rate for Payer: Group Health Inc Medicare |
$28.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$52.65
|
|
|
HC DERMAVEST, PER SQ CM
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT Q4153
|
| Hospital Charge Code |
636Q415301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.00
|
|
|
HC DERMAVEST, PER SQ CM
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT Q4153
|
| Hospital Charge Code |
636Q415301
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$114.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$47.60
|
| Rate for Payer: Aetna Government |
$47.60
|
| Rate for Payer: Brighton Health Commercial |
$124.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$104.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.60
|
| Rate for Payer: EmblemHealth Commercial |
$104.00
|
| Rate for Payer: Group Health Inc Commercial |
$104.00
|
| Rate for Payer: Group Health Inc Medicare |
$72.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$104.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$104.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$135.20
|
|
