|
HC INCISE EXT THROMBOSED HEMORRHOIDS
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
5104608301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$355.50 |
| Max. Negotiated Rate |
$355.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$355.50
|
|
|
HC INCISE EXT THROMBOSED HEMORRHOIDS
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
5104608301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.53 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$297.16
|
| Rate for Payer: Aetna Government |
$297.16
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$208.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$208.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$208.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$297.16
|
| 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 |
$297.16
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$267.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$252.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$264.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$297.16
|
| Rate for Payer: Fidelis Qualified Health Plan |
$264.47
|
| 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 |
$297.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$130.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$252.59
|
| Rate for Payer: Healthfirst QHP |
$297.16
|
| Rate for Payer: Humana Medicare |
$303.10
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$312.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$297.16
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$297.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$297.16
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$282.30
|
| Rate for Payer: Wellcare Medicare |
$282.30
|
|
|
HC INCISIONAL BIOPSY, SKIN, EACH ADD'L LESION (ADDON)
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
3611110701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27.85
|
| Rate for Payer: Aetna Government |
$27.85
|
| Rate for Payer: Brighton Health Commercial |
$356.25
|
| 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 |
$237.50
|
| Rate for Payer: Group Health Inc Commercial |
$237.50
|
| Rate for Payer: Group Health Inc Medicare |
$166.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$237.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34.34
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INCISIONAL BIOPSY, SKIN, EACH ADD'L LESION (ADDON)
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 11107
|
| Hospital Charge Code |
3611110701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.50 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$237.50
|
|
|
HC INCISIONAL BIOPSY, SKIN, SINGLE LESION
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
3611110601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$475.00
|
|
|
HC INCISIONAL BIOPSY, SKIN, SINGLE LESION
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
3611110601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$712.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$111.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$64.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC INCISION/DRAIN ABSCESS EXTRA
|
Facility
|
IP
|
$8,750.00
|
|
|
Service Code
|
CPT D7521
|
| Hospital Charge Code |
361D752101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,375.00 |
| Max. Negotiated Rate |
$4,375.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,375.00
|
|
|
HC INCISION/DRAIN ABSCESS EXTRA
|
Facility
|
OP
|
$8,750.00
|
|
|
Service Code
|
CPT D7521
|
| Hospital Charge Code |
361D752101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$7,000.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,812.50
|
| 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 |
$6,562.50
|
| 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 |
$7,000.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5,950.00
|
| 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 INCISION/DRAIN ABSCESS INTRAORAR
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT D7511
|
| Hospital Charge Code |
361D751101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$876.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$211.75
|
| 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 |
$288.75
|
| 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 |
$308.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$261.80
|
| 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 INCISION/DRAIN ABSCESS INTRAORAR
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT D7511
|
| Hospital Charge Code |
361D751101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$192.50
|
|
|
HC INCISION OF ANAL ABCESS
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
5104605001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,156.50 |
| Max. Negotiated Rate |
$1,156.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,156.50
|
|
|
HC INCISION OF ANAL ABCESS
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
5104605001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.43 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,113.95
|
| Rate for Payer: Aetna Government |
$1,113.95
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$779.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$779.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$779.76
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,113.95
|
| 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 |
$1,113.95
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,002.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$946.86
|
| Rate for Payer: Fidelis Essential Plan QHP |
$991.42
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,113.95
|
| Rate for Payer: Fidelis Qualified Health Plan |
$991.42
|
| 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 |
$1,113.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$489.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$120.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$946.86
|
| Rate for Payer: Healthfirst QHP |
$1,113.95
|
| Rate for Payer: Humana Medicare |
$1,136.23
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,169.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,113.95
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,113.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,113.95
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,058.25
|
| Rate for Payer: Wellcare Medicare |
$1,058.25
|
|
|
HC INCISION OF EYELID
|
Facility
|
OP
|
$2,341.00
|
|
|
Service Code
|
CPT 67710
|
| Hospital Charge Code |
5106771001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$110.51 |
| Max. Negotiated Rate |
$1,242.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,183.38
|
| Rate for Payer: Aetna Government |
$1,183.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$828.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$828.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$828.37
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.38
|
| 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 |
$1,183.38
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,053.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,053.21
|
| 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 |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$189.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$110.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.87
|
| Rate for Payer: Healthfirst QHP |
$1,183.38
|
| Rate for Payer: Humana Medicare |
$1,207.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,242.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,183.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,124.21
|
| Rate for Payer: Wellcare Medicare |
$1,124.21
|
|
|
HC INCISION OF EYELID
|
Facility
|
IP
|
$2,341.00
|
|
|
Service Code
|
CPT 67710
|
| Hospital Charge Code |
5106771001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,170.50 |
| Max. Negotiated Rate |
$1,170.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,170.50
|
|
|
HC INCISION OF IRIS
|
Facility
|
IP
|
$6,123.00
|
|
|
Service Code
|
CPT 66500
|
| Hospital Charge Code |
5106650001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,061.50 |
| Max. Negotiated Rate |
$3,061.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.50
|
|
|
HC INCISION OF IRIS
|
Facility
|
OP
|
$6,123.00
|
|
|
Service Code
|
CPT 66500
|
| Hospital Charge Code |
5106650001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,925.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,786.64
|
| Rate for Payer: Aetna Government |
$2,786.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,950.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,950.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,950.65
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,786.64
|
| 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 |
$2,786.64
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,507.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,368.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,480.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,786.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,480.11
|
| 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 |
$2,786.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,214.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$441.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,368.64
|
| Rate for Payer: Healthfirst QHP |
$2,786.64
|
| Rate for Payer: Humana Medicare |
$2,842.37
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,925.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,786.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,786.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,786.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,647.31
|
| Rate for Payer: Wellcare Medicare |
$2,647.31
|
|
|
HC INCSN & REMOVAL FOREIGN BODY, COMPLICATED
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
3611012101
|
|
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 INCSN & REMOVAL FOREIGN BODY, COMPLICATED
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
3611012101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.43 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$212.43
|
| 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 INCSN & REMOVAL FOREIGN BODY, SIMPLE
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
3611012001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC INCSN & REMOVAL FOREIGN BODY, SIMPLE
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
3611012001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.86 |
| 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 |
$102.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.33
|
| 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 INDUCED ABORTION W/SUPPOSITORY
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59855
|
| Hospital Charge Code |
3615985501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC INDUCED ABORTION W/SUPPOSITORY
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59855
|
| Hospital Charge Code |
3615985501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$502.07 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,161.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$502.07
|
| Rate for Payer: Aetna Government |
$502.07
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: EmblemHealth Commercial |
$3,783.00
|
| Rate for Payer: Group Health Inc Commercial |
$3,783.00
|
| Rate for Payer: Group Health Inc Medicare |
$2,648.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,783.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$516.33
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC INDUCTION OF VOMITING
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 99175
|
| Hospital Charge Code |
5109917501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.50 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$41.50
|
|
|
HC INDUCTION OF VOMITING
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 99175
|
| Hospital Charge Code |
5109917501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.42 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$45.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$15.42
|
| Rate for Payer: Aetna Government |
$15.42
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$41.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$41.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$35.16
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC INFACTIOUS AGENT DETECT, DNA/RNA, HPV, HIGH-RISK
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3068762401
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$69.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$35.09
|
| Rate for Payer: Aetna Government |
$35.09
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$24.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$24.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24.56
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$69.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$59.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$35.09
|
| Rate for Payer: EmblemHealth Commercial |
$35.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$31.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$29.83
|
| Rate for Payer: Fidelis Essential Plan QHP |
$31.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$35.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31.23
|
| Rate for Payer: Group Health Inc Commercial |
$35.09
|
| Rate for Payer: Group Health Inc Medicare |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$35.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$35.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28.13
|
| Rate for Payer: Healthfirst Essential Plan |
$63.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$35.09
|
| Rate for Payer: Healthfirst QHP |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare Commercial |
$42.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$35.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.13
|
| Rate for Payer: Wellcare Medicare |
$31.58
|
|
