|
HC I&D MOUTH/TONG INTRA,MASTICATOR
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 41009
|
| Hospital Charge Code |
3614100901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.04 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$1,027.50
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: Group Health Inc Medicare |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.78
|
| 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: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 I&D MOUTH/TONG INTRA,SUBLING,SUPERF
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
CPT 41005
|
| Hospital Charge Code |
3614100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$467.25
|
| 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: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| 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 |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$136.69
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC I&D MOUTH/TONG INTRA,SUBLING,SUPERF
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
CPT 41005
|
| Hospital Charge Code |
3614100501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$311.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.50
|
|
|
HC I&D MOUTH/TONG INTRA,SUBLINGUAL,DEEP
|
Facility
|
OP
|
$4,086.00
|
|
|
Service Code
|
CPT 41006
|
| Hospital Charge Code |
4504100601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,900.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,809.86
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,900.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC I&D MOUTH/TONG INTRA,SUBLINGUAL,DEEP
|
Facility
|
IP
|
$4,086.00
|
|
|
Service Code
|
CPT 41006
|
| Hospital Charge Code |
4504100601
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.00
|
|
|
HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR
|
Facility
|
IP
|
$7,933.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
4504101701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,966.50 |
| Max. Negotiated Rate |
$3,966.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.50
|
|
|
HC I&D MOUTH/TONG INTRA,SUBMANDIBULAR
|
Facility
|
OP
|
$7,933.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
4504101701
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$4,160.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,962.45
|
| Rate for Payer: Aetna Government |
$3,962.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,773.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,773.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,773.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,962.45
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,962.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,962.45
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,566.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,368.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,526.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,962.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,526.58
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,394.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,962.45
|
| Rate for Payer: Humana Medicare |
$4,041.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,160.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,962.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,962.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,764.33
|
| Rate for Payer: Wellcare Medicare |
$3,764.33
|
|
|
HC I&D MOUTH/TONG INTRA,SUBMENTAL
|
Facility
|
IP
|
$4,163.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
3614100701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,081.50 |
| Max. Negotiated Rate |
$2,081.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,081.50
|
|
|
HC I&D MOUTH/TONG INTRA,SUBMENTAL
|
Facility
|
OP
|
$4,163.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
3614100701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.64 |
| Max. Negotiated Rate |
$3,122.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$3,122.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| 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 |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$1,809.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,809.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$256.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC I&D OF SKIN ABCESS, COMPLEX
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3611006101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC I&D OF SKIN ABCESS, COMPLEX
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3611006101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.36 |
| 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 |
$119.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.02
|
| 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 I&D OF SKIN ABCESS, SIMPLE
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3611006001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$273.50 |
| Max. Negotiated Rate |
$273.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.50
|
|
|
HC I&D OF SKIN ABCESS, SIMPLE
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3611006001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.54 |
| 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 |
$410.25
|
| 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 |
$80.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$123.43
|
| 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 I&D OF VULVA/PERINEUM ABSCESS
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
5105640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.75 |
| Max. Negotiated Rate |
$390.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$260.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$260.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$260.17
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| 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 |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$334.50
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$315.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$330.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$330.79
|
| 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 |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$84.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$149.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$371.67
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$390.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$353.09
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC I&D OF VULVA/PERINEUM ABSCESS
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
5105640501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC I & D PENILE ABSCESS, DEEP
|
Facility
|
OP
|
$4,264.00
|
|
|
Service Code
|
CPT 54015
|
| Hospital Charge Code |
3615401501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$346.87 |
| Max. Negotiated Rate |
$3,198.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$3,198.00
|
| 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 |
$346.87
|
| 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 PENILE ABSCESS, DEEP
|
Facility
|
IP
|
$4,264.00
|
|
|
Service Code
|
CPT 54015
|
| Hospital Charge Code |
3615401501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,132.00 |
| Max. Negotiated Rate |
$2,132.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,132.00
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
5104604001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,134.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| 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 |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| 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 |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$509.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,512.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
7614604001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,440.62
|
| Rate for Payer: Aetna Government |
$1,440.62
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,008.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,008.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,008.43
|
| Rate for Payer: Brighton Health Commercial |
$2,280.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,440.62
|
| 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 |
$1,440.62
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,296.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,224.53
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,282.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,440.62
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,282.15
|
| 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 |
$1,440.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$509.93
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,224.53
|
| Rate for Payer: Healthfirst QHP |
$1,440.62
|
| Rate for Payer: Humana Medicare |
$1,469.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,440.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,440.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,440.62
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,368.59
|
| Rate for Payer: Wellcare Medicare |
$1,368.59
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
7614604001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,520.50 |
| Max. Negotiated Rate |
$1,520.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.50
|
|
|
HC I&D PERIRECTAL ABSCESS
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
5104604001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,520.50 |
| Max. Negotiated Rate |
$1,520.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,520.50
|
|
|
HC I&D PERITONSIL ABSCESS
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
5104270001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC I&D PERITONSIL ABSCESS
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
5104270001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| 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 |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$160.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC I&D PILONIDAL CYST, COMPLEX
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
3611008101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC I&D PILONIDAL CYST, COMPLEX
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
3611008101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$201.65 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$231.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$201.65
|
| 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
|
|
