|
HC DESCENDING THORACIC AORTA GRAFT
|
Facility
|
OP
|
$6,768.00
|
|
|
Service Code
|
CPT 33875 TC
|
| Hospital Charge Code |
3613387501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$5,076.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,722.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,085.67
|
| Rate for Payer: Aetna Government |
$3,085.67
|
| Rate for Payer: Brighton Health Commercial |
$5,076.00
|
| 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 |
$3,384.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,384.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,368.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,384.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,384.00
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC DESCENDING THORACIC AORTA GRAFT
|
Facility
|
IP
|
$6,768.00
|
|
|
Service Code
|
CPT 33875 TC
|
| Hospital Charge Code |
3613387501
|
|
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 DEST BY NEUR AGENT CER/THOR EA AD
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
3616463401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.86 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$78.07
|
| Rate for Payer: Aetna Government |
$78.07
|
| Rate for Payer: Brighton Health Commercial |
$342.75
|
| 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 |
$228.50
|
| Rate for Payer: Group Health Inc Commercial |
$228.50
|
| Rate for Payer: Group Health Inc Medicare |
$159.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$74.86
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DEST BY NEUR AGENT CER/THOR EA AD
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
3616463401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$228.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.50
|
|
|
HC DEST BY NEUR AGENT INTERCOSTAL NERVE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
5106462001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| 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 |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$204.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC DEST BY NEUR AGENT INTERCOSTAL NERVE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64620
|
| Hospital Charge Code |
5106462001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC DEST BY NEUR AGENT LUMBAR OR SAC, EA ADTL
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
3616463601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$68.06
|
| Rate for Payer: Aetna Government |
$68.06
|
| Rate for Payer: Brighton Health Commercial |
$981.00
|
| 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 |
$654.00
|
| Rate for Payer: Group Health Inc Commercial |
$654.00
|
| Rate for Payer: Group Health Inc Medicare |
$457.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$654.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$654.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$66.01
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DEST BY NEUR AGENT LUMBAR OR SAC, EA ADTL
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
3616463601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.00 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$654.00
|
|
|
HC DEST BY NEUR AGENT LUMB/SAC SINGL
|
Facility
|
OP
|
$5,207.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
3616463501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.14 |
| Max. Negotiated Rate |
$3,905.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,385.93
|
| Rate for Payer: Aetna Government |
$2,385.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,670.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,670.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,670.15
|
| Rate for Payer: Brighton Health Commercial |
$3,905.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,385.93
|
| 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 |
$2,385.93
|
| Rate for Payer: EmblemHealth Commercial |
$2,385.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,147.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,028.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,123.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,385.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,123.48
|
| Rate for Payer: Group Health Inc Commercial |
$2,385.93
|
| Rate for Payer: Group Health Inc Medicare |
$2,385.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,385.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,028.04
|
| Rate for Payer: Healthfirst QHP |
$2,385.93
|
| Rate for Payer: Humana Medicare |
$2,433.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,385.93
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,385.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,385.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,266.63
|
| Rate for Payer: Wellcare Medicare |
$2,266.63
|
|
|
HC DEST BY NEUR AGENT LUMB/SAC SINGL
|
Facility
|
IP
|
$5,207.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
3616463501
|
|
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 DEST BY NEUR AGENT PUDENAL NERVE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
5106463001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC DEST BY NEUR AGENT PUDENAL NERVE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64630
|
| Hospital Charge Code |
5106463001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| 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 |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$224.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC DEST BY NEUR AGENT TRIGEMINAL NERVE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
5106460001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| 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 |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$287.05
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC DEST BY NEUR AGENT TRIGEMINAL NERVE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64600
|
| Hospital Charge Code |
5106460001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC DEST BY NEUR AGENT W/IMAGING
|
Facility
|
IP
|
$5,207.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
3616463301
|
|
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 DEST BY NEUR AGENT W/IMAGING
|
Facility
|
OP
|
$5,207.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
3616463301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.37 |
| Max. Negotiated Rate |
$3,905.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,385.93
|
| Rate for Payer: Aetna Government |
$2,385.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,670.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,670.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,670.15
|
| Rate for Payer: Brighton Health Commercial |
$3,905.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,385.93
|
| 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 |
$2,385.93
|
| Rate for Payer: EmblemHealth Commercial |
$2,385.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,147.34
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,028.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,123.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,385.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,123.48
|
| Rate for Payer: Group Health Inc Commercial |
$2,385.93
|
| Rate for Payer: Group Health Inc Medicare |
$2,385.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,385.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$924.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$216.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,028.04
|
| Rate for Payer: Healthfirst QHP |
$2,385.93
|
| Rate for Payer: Humana Medicare |
$2,433.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,385.93
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,385.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,385.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,266.63
|
| Rate for Payer: Wellcare Medicare |
$2,266.63
|
|
|
HC DESTR BENIGN LESIONS, <=14 LESIONS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
3611711001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DESTR BENIGN LESIONS, <=14 LESIONS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
3611711001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC DESTR BENIGN LESIONS, >=15 LESIONS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
3611711101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.04 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$242.78
|
| Rate for Payer: Aetna Government |
$242.78
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$169.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$169.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$169.95
|
| Rate for Payer: Brighton Health Commercial |
$396.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$242.78
|
| 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 |
$242.78
|
| Rate for Payer: EmblemHealth Commercial |
$242.78
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$218.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$206.36
|
| Rate for Payer: Fidelis Essential Plan QHP |
$216.07
|
| Rate for Payer: Fidelis Medicare Advantage |
$242.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$216.07
|
| Rate for Payer: Group Health Inc Commercial |
$242.78
|
| Rate for Payer: Group Health Inc Medicare |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$242.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$97.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$206.36
|
| Rate for Payer: Healthfirst QHP |
$242.78
|
| Rate for Payer: Humana Medicare |
$247.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$242.78
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$242.78
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$230.64
|
| Rate for Payer: Wellcare Medicare |
$230.64
|
|
|
HC DESTR BENIGN LESIONS, >=15 LESIONS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 17111
|
| Hospital Charge Code |
3611711101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC DESTRCN,PREMALIGNT LESION, >=15 LESIONS
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
3611700401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC DESTRCN,PREMALIGNT LESION, >=15 LESIONS
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 17004
|
| Hospital Charge Code |
3611700401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.24 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$725.25
|
| 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 |
$112.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$113.37
|
| 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 DESTRCN,PREMALIGNT LESION, 2-14 LESIONS (ADDON)
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
3611700301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.17
|
| Rate for Payer: Aetna Government |
$2.17
|
| Rate for Payer: Brighton Health Commercial |
$198.00
|
| 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 |
$132.00
|
| Rate for Payer: Group Health Inc Commercial |
$132.00
|
| Rate for Payer: Group Health Inc Medicare |
$92.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$132.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.15
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC DESTRCN,PREMALIGNT LESION, 2-14 LESIONS (ADDON)
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 17003
|
| Hospital Charge Code |
3611700301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$132.00
|
|
|
HC DESTRCN,PREMALIGNT LESION, FIRST LESION
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
3611700001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
