|
HC I & D ABSCESS-EXTRAORAL-SOFT TISS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT D7520
|
| Hospital Charge Code |
361D752001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$192.50
|
| 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 |
$262.50
|
| 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 |
$280.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$238.00
|
| 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 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 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 I & D ABSCESS-EXTRAORAL-SOFT TISS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT D7520
|
| Hospital Charge Code |
361D752001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$175.00
|
|
|
HC I & D ABSCESS INTRAORAL-SOFT TISS
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT D7510
|
| Hospital Charge Code |
361D751001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$87.50
|
|
|
HC I & D ABSCESS INTRAORAL-SOFT TISS
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT D7510
|
| Hospital Charge Code |
361D751001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.25 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$96.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$241.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$241.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.36
|
| Rate for Payer: Amida Care Medicaid |
$107.36
|
| Rate for Payer: Brighton Health Commercial |
$131.25
|
| 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 |
$140.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$119.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$241.56
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$107.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$107.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$241.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$112.73
|
| 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 |
$107.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$107.36
|
| Rate for Payer: Healthfirst Essential Plan |
$241.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$175.00
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$107.36
|
| Rate for Payer: SOMOS Essential |
$241.56
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$241.56
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$118.10
|
| Rate for Payer: United Healthcare Medicaid |
$107.36
|
| 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 |
$107.36
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
5105642001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
3615642001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.79
|
| Rate for Payer: Aetna Government |
$245.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.05
|
| Rate for Payer: Brighton Health Commercial |
$376.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.79
|
| 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 |
$245.79
|
| Rate for Payer: EmblemHealth Commercial |
$245.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.75
|
| Rate for Payer: Group Health Inc Commercial |
$245.79
|
| Rate for Payer: Group Health Inc Medicare |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$245.79
|
| Rate for Payer: Humana Medicare |
$250.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.79
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.50
|
| Rate for Payer: Wellcare Medicare |
$233.50
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
5105642001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$245.79
|
| Rate for Payer: Aetna Government |
$245.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.05
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$245.79
|
| 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 |
$245.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$221.21
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$208.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$218.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$245.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$218.75
|
| 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 |
$245.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$108.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$245.79
|
| Rate for Payer: Humana Medicare |
$250.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$258.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$245.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$245.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$245.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$233.50
|
| Rate for Payer: Wellcare Medicare |
$233.50
|
|
|
HC I&D BARTHOLIN GLAND ABSCESS
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
3615642001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC I&D BELOW FASCIA, FOOT, SINGLE BURSAL SPACE
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
3612800201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,052.50 |
| Max. Negotiated Rate |
$2,052.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.50
|
|
|
HC I&D BELOW FASCIA, FOOT, SINGLE BURSAL SPACE
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
3612800201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.75 |
| 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 |
$156.75
|
| 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 I&D COMPLEX, POSTOP WOUND INFECTION
|
Facility
|
IP
|
$7,023.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
3611018001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,511.50 |
| Max. Negotiated Rate |
$3,511.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,511.50
|
|
|
HC I&D COMPLEX, POSTOP WOUND INFECTION
|
Facility
|
OP
|
$7,023.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
3611018001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.07 |
| Max. Negotiated Rate |
$5,267.25 |
| 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 |
$5,267.25
|
| 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 |
$213.07
|
| 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 |
$1,468.00
|
| 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 I&D DEEP ABSC/HEMATOMA NECK/CHEST
|
Facility
|
IP
|
$7,747.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
3612150101
|
|
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 I&D DEEP ABSC/HEMATOMA NECK/CHEST
|
Facility
|
OP
|
$7,747.00
|
|
|
Service Code
|
CPT 21501
|
| Hospital Charge Code |
3612150101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.61 |
| 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 |
$403.61
|
| 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 |
$1,468.00
|
| 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 I&D DEEP SUPRALEVATOR/RECTAL ABSCESS
|
Facility
|
OP
|
$7,099.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
3614502001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$677.13 |
| Max. Negotiated Rate |
$5,324.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,350.71
|
| Rate for Payer: Aetna Government |
$3,350.71
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,345.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,345.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,345.50
|
| Rate for Payer: Brighton Health Commercial |
$5,324.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,350.71
|
| 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 |
$3,350.71
|
| Rate for Payer: EmblemHealth Commercial |
$3,350.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,015.64
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,848.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,982.13
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,350.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,982.13
|
| Rate for Payer: Group Health Inc Commercial |
$3,350.71
|
| Rate for Payer: Group Health Inc Medicare |
$3,350.71
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,350.71
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,397.97
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$677.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,848.10
|
| Rate for Payer: Healthfirst QHP |
$3,350.71
|
| Rate for Payer: Humana Medicare |
$3,417.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,350.71
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,350.71
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,350.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,183.17
|
| Rate for Payer: Wellcare Medicare |
$3,183.17
|
|
|
HC I&D DEEP SUPRALEVATOR/RECTAL ABSCESS
|
Facility
|
IP
|
$7,099.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
3614502001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,549.50 |
| Max. Negotiated Rate |
$3,549.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,549.50
|
|
|
HC I & D EXTERNAL EAR
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
5106900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC I & D EXTERNAL EAR
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
5106900001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.24 |
| Max. Negotiated Rate |
$902.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$123.24
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$146.01
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$902.64
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 I&D, FOOT, BURSA, FOOT
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 28001
|
| Hospital Charge Code |
3612800101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$94.78 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$94.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.74
|
| 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 |
$1,409.00
|
| 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 I&D, FOOT, BURSA, FOOT
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 28001
|
| Hospital Charge Code |
3612800101
|
|
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 I&D FOREARM/WRIST, DP ABCS OR HEMATOMA
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
3612502801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$807.66 |
| Max. Negotiated Rate |
$6,218.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,964.33
|
| Rate for Payer: Aetna Government |
$3,964.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,775.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,775.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,775.03
|
| Rate for Payer: Brighton Health Commercial |
$6,218.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,964.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,964.33
|
| Rate for Payer: EmblemHealth Commercial |
$3,964.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,567.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,369.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,528.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,964.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,528.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,964.33
|
| Rate for Payer: Group Health Inc Medicare |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,579.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$807.66
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,369.68
|
| Rate for Payer: Healthfirst QHP |
$3,964.33
|
| Rate for Payer: Humana Medicare |
$4,043.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,964.33
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,964.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,964.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,766.11
|
| Rate for Payer: Wellcare Medicare |
$3,766.11
|
|
|
HC I&D FOREARM/WRIST, DP ABCS OR HEMATOMA
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
3612502801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,145.50 |
| Max. Negotiated Rate |
$4,145.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.50
|
|
|
HC I&D HEMATOME/SEREROMA/FLUID COLLN
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
3611014001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.74 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$106.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.67
|
| 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 |
$1,409.00
|
| 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 I&D HEMATOME/SEREROMA/FLUID COLLN
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
3611014001
|
|
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 I&D MOUTH/TONG INTRA,MASTICATOR
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 41009
|
| Hospital Charge Code |
3614100901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.00 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$685.00
|
|
