|
HC INJECT/TREAT EYE SOCKET
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 67515
|
| Hospital Charge Code |
5106751501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC INJECT TRIGGER POINT, 1 OR 2
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
3612055202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27.17
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$41.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC INJECT TRIGGER POINT, 1 OR 2
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20552
|
| Hospital Charge Code |
3612055202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJECT TRIGGER POINTS, > 3
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
3612055302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC INJECT TRIGGER POINTS, > 3
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20553
|
| Hospital Charge Code |
3612055302
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJ ENZYME, PALMAR FASCIAL CORD
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
3612052701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJ ENZYME, PALMAR FASCIAL CORD
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20527
|
| Hospital Charge Code |
3612052701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.87 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$47.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI
|
Facility
|
IP
|
$439.00
|
|
|
Service Code
|
CPT 23350 TC
|
| Hospital Charge Code |
3612335001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.50 |
| Max. Negotiated Rate |
$219.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.50
|
|
|
HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI
|
Facility
|
OP
|
$439.00
|
|
|
Service Code
|
CPT 23350 TC
|
| Hospital Charge Code |
3612335001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.90 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$130.90
|
| Rate for Payer: Aetna Government |
$130.90
|
| Rate for Payer: Brighton Health Commercial |
$329.25
|
| 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 |
$219.50
|
| Rate for Payer: Group Health Inc Commercial |
$219.50
|
| Rate for Payer: Group Health Inc Medicare |
$153.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$219.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$219.50
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC INJ. SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
3612055101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJ. SINGLE TENDON ORIGIN/INSERTION
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20551
|
| Hospital Charge Code |
3612055101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC INJ SINGLE TENDON SHEATH/LIGAMENT/APONEUROSIS
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
3612055001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJ SINGLE TENDON SHEATH/LIGAMENT/APONEUROSIS
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
3612055001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.11 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$360.67
|
| Rate for Payer: Aetna Government |
$360.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$252.47
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$252.47
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$252.47
|
| Rate for Payer: Brighton Health Commercial |
$594.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$360.67
|
| 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 |
$360.67
|
| Rate for Payer: EmblemHealth Commercial |
$360.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.60
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$306.57
|
| Rate for Payer: Fidelis Essential Plan QHP |
$321.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$360.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$321.00
|
| Rate for Payer: Group Health Inc Commercial |
$360.67
|
| Rate for Payer: Group Health Inc Medicare |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$360.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$44.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$306.57
|
| Rate for Payer: Healthfirst QHP |
$360.67
|
| Rate for Payer: Humana Medicare |
$367.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$360.67
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$360.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$342.64
|
| Rate for Payer: Wellcare Medicare |
$342.64
|
|
|
HC INJX AA&/STRD - AXILLARY NERVE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
5106441701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.18 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC INJX AA&/STRD - AXILLARY NERVE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
5106441701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJX AA&/STRD - BRACHIAL PLEXUS,CONT INFUS
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
5106441601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJX AA&/STRD - BRACHIAL PLEXUS,CONT INFUS
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
5106441601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$1,142.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$605.77
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$85.10
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC INJX AA&/STRD - BRACHIAL PLEXUS, SINGLE
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
5106441501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJX AA&/STRD - BRACHIAL PLEXUS, SINGLE
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
5106441501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$77.18 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$477.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$77.18
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC INJX AA&/STRD - FACIAL NERVE
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
5106440201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$396.00
|
| Rate for Payer: Aetna Government |
$396.00
|
| 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 |
$396.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
|
|
HC INJX AA&/STRD - FACIAL NERVE
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 64402
|
| Hospital Charge Code |
5106440201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$396.00
|
|
|
HC INJX AA&/STRD - FEMORAL NERVE, CONT INFUS
|
Facility
|
IP
|
$2,459.00
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
5106444801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,229.50 |
| Max. Negotiated Rate |
$1,229.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,229.50
|
|
|
HC INJX AA&/STRD - FEMORAL NERVE, CONT INFUS
|
Facility
|
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 64448
|
| Hospital Charge Code |
5106444801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.57 |
| Max. Negotiated Rate |
$1,142.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,087.77
|
| Rate for Payer: Aetna Government |
$1,087.77
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$761.44
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$761.44
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$761.44
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,087.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,087.77
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$978.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$924.60
|
| Rate for Payer: Fidelis Essential Plan QHP |
$968.12
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,087.77
|
| Rate for Payer: Fidelis Qualified Health Plan |
$968.12
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,087.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$608.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$79.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$924.60
|
| Rate for Payer: Healthfirst QHP |
$1,087.77
|
| Rate for Payer: Humana Medicare |
$1,109.53
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,142.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,087.77
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,087.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,087.77
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,033.38
|
| Rate for Payer: Wellcare Medicare |
$1,033.38
|
|
|
HC INJX AA&/STRD - FEMORAL NERVE,SINGLE
|
Facility
|
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
3616444701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.02 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$846.13
|
| Rate for Payer: Aetna Government |
$846.13
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$592.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$592.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$592.29
|
| Rate for Payer: Brighton Health Commercial |
$1,419.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$846.13
|
| 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 |
$846.13
|
| Rate for Payer: EmblemHealth Commercial |
$846.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$761.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$719.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$753.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$846.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$753.06
|
| Rate for Payer: Group Health Inc Commercial |
$846.13
|
| Rate for Payer: Group Health Inc Medicare |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$846.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$70.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$719.21
|
| Rate for Payer: Healthfirst QHP |
$846.13
|
| Rate for Payer: Humana Medicare |
$863.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$846.13
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$846.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$846.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$803.82
|
| Rate for Payer: Wellcare Medicare |
$803.82
|
|
|
HC INJX AA&/STRD - FEMORAL NERVE,SINGLE
|
Facility
|
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
3616444701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$946.50 |
| Max. Negotiated Rate |
$946.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$946.50
|
|
