|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 12.6-20.0CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
3611203501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.39 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$214.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$282.56
|
| 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 INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 20.1-30.0CM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
3611203601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 20.1-30.0CM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
3611203601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.29 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$1,128.75
|
| 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 |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$332.79
|
| 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 |
$1,113.00
|
| 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 INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, <2.5CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
3611203101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, <2.5CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 12031
|
| Hospital Charge Code |
3611203101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$174.17 |
| 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 |
$180.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$174.17
|
| 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 INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 2.6-7.5CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
3611203201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 2.6-7.5CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
3611203201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.14 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$203.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$218.86
|
| 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 INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, >30.0CM
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
3611203701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$2,457.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,457.00
|
|
|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, >30.0CM
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 12037
|
| Hospital Charge Code |
3611203701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$385.97 |
| Max. Negotiated Rate |
$3,685.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$3,685.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$385.97
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 7.6-12.5CM
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
3611203401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC INTRMED WND REP, SCALP/AXILLAE/TRUNK/EXT, 7.6-12.5CM
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
3611203401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.39 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$214.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$236.27
|
| 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 INTRODUCTION NEEDLE/CATH DIALYSIS CIRCUIT
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
3613690101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
|
|
HC INTRODUCTION NEEDLE/CATH DIALYSIS CIRCUIT
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 36901
|
| Hospital Charge Code |
3613690101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.04 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,898.02
|
| Rate for Payer: Aetna Government |
$1,898.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,328.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,328.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,328.61
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,898.02
|
| 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 |
$1,898.02
|
| Rate for Payer: EmblemHealth Commercial |
$1,898.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,708.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,613.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,689.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,898.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,689.24
|
| Rate for Payer: Group Health Inc Commercial |
$1,898.02
|
| Rate for Payer: Group Health Inc Medicare |
$1,898.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,898.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$528.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$189.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,613.32
|
| Rate for Payer: Healthfirst QHP |
$1,898.02
|
| Rate for Payer: Humana Medicare |
$1,935.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,898.02
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,898.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,898.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,803.12
|
| Rate for Payer: Wellcare Medicare |
$1,803.12
|
|
|
HC INTRODUCTION NEEDLE/CATH DIALYSIS CIRCUIT, W/STENT PLACEMENT
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
3613690301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC INTRODUCTION NEEDLE/CATH DIALYSIS CIRCUIT, W/STENT PLACEMENT
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 36903
|
| Hospital Charge Code |
3613690301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$22,507.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13,856.14
|
| Rate for Payer: Aetna Government |
$13,856.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,699.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,699.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9,699.30
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13,856.14
|
| 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 |
$13,856.14
|
| Rate for Payer: EmblemHealth Commercial |
$13,856.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,470.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11,777.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12,331.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,856.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12,331.96
|
| Rate for Payer: Group Health Inc Commercial |
$13,856.14
|
| Rate for Payer: Group Health Inc Medicare |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,351.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$353.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,777.72
|
| Rate for Payer: Healthfirst QHP |
$13,856.14
|
| Rate for Payer: Humana Medicare |
$14,133.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13,856.14
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,856.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,856.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,163.33
|
| Rate for Payer: Wellcare Medicare |
$13,163.33
|
|
|
HC INTRODUCTION NEEDLE/CATH DIALYSIS CIRCUIT, W/TRANSLUMINAL BALLOON ANGIOPLASTY
|
Facility
|
IP
|
$15,004.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
3613690201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,502.00 |
| Max. Negotiated Rate |
$7,502.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.00
|
|
|
HC INTRODUCTION NEEDLE/CATH DIALYSIS CIRCUIT, W/TRANSLUMINAL BALLOON ANGIOPLASTY
|
Facility
|
OP
|
$15,004.00
|
|
|
Service Code
|
CPT 36902
|
| Hospital Charge Code |
3613690201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.34 |
| Max. Negotiated Rate |
$11,253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,966.23
|
| Rate for Payer: Aetna Government |
$6,966.23
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,876.36
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,876.36
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,876.36
|
| Rate for Payer: Brighton Health Commercial |
$11,253.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,966.23
|
| 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 |
$6,966.23
|
| Rate for Payer: EmblemHealth Commercial |
$6,966.23
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6,269.61
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,921.30
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6,199.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,966.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6,199.94
|
| Rate for Payer: Group Health Inc Commercial |
$6,966.23
|
| Rate for Payer: Group Health Inc Medicare |
$6,966.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,966.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,629.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,921.30
|
| Rate for Payer: Healthfirst QHP |
$6,966.23
|
| Rate for Payer: Humana Medicare |
$7,105.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,966.23
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,966.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,966.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,617.92
|
| Rate for Payer: Wellcare Medicare |
$6,617.92
|
|
|
HC INTRODUCTION OF HEMOSTATIC AGENT
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
3615718001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC INTRODUCTION OF HEMOSTATIC AGENT
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
3615718001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$141.00
|
| 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 INTRO LONG GI TUBE - NASAL JEJUNAL FEEDING TUBE
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
7504450001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,237.50 |
| Max. Negotiated Rate |
$1,237.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,237.50
|
|
|
HC INTRO LONG GI TUBE - NASAL JEJUNAL FEEDING TUBE
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
7504450001
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$21.34 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,145.53
|
| Rate for Payer: Aetna Government |
$1,145.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$801.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$801.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$801.87
|
| Rate for Payer: Brighton Health Commercial |
$1,856.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,145.53
|
| 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 |
$1,145.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,145.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,030.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$973.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,019.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,145.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,019.52
|
| Rate for Payer: Group Health Inc Commercial |
$1,145.53
|
| Rate for Payer: Group Health Inc Medicare |
$1,145.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,145.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$503.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$973.70
|
| Rate for Payer: Healthfirst QHP |
$1,145.53
|
| Rate for Payer: Humana Medicare |
$1,168.44
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,145.53
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,145.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,145.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,088.25
|
| Rate for Payer: Wellcare Medicare |
$1,088.25
|
|
|
HC INVESTIIGATION OF TRANSFUSION REACTION,INCL INTERP&RPT
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
3058607801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$238.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$209.37
|
| Rate for Payer: Aetna Government |
$209.37
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.56
|
| Rate for Payer: Brighton Health Commercial |
$325.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$209.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$209.37
|
| Rate for Payer: EmblemHealth Commercial |
$52.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.43
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.96
|
| Rate for Payer: Fidelis Essential Plan QHP |
$186.34
|
| Rate for Payer: Fidelis Medicare Advantage |
$209.37
|
| Rate for Payer: Fidelis Qualified Health Plan |
$186.34
|
| Rate for Payer: Group Health Inc Commercial |
$209.37
|
| Rate for Payer: Group Health Inc Medicare |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.37
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$209.37
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.71
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.37
|
| Rate for Payer: Healthfirst QHP |
$209.37
|
| Rate for Payer: Humana Medicare |
$213.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$209.37
|
| Rate for Payer: United Healthcare Commercial |
$32.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.37
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$209.37
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.90
|
| Rate for Payer: Wellcare Medicare |
$188.43
|
|
|
HC INVESTIIGATION OF TRANSFUSION REACTION,INCL INTERP&RPT
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 86078
|
| Hospital Charge Code |
3058607801
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$217.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$217.00
|
|
|
HC IRIDOPLASTY BY PHOTOCOAGULTON 1>
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 66762
|
| Hospital Charge Code |
5106676201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$1,536.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$670.29
|
| Rate for Payer: Aetna Government |
$670.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,536.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$682.93
|
| Rate for Payer: Amida Care Medicaid |
$682.93
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.29
|
| 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 |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$682.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,536.59
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,536.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$717.07
|
| 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 |
$682.93
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$270.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Healthfirst Essential Plan |
$1,536.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.75
|
| Rate for Payer: Healthfirst QHP |
$1,113.17
|
| Rate for Payer: Humana Medicare |
$683.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$682.93
|
| Rate for Payer: SOMOS Essential |
$1,536.59
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$1,536.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$751.21
|
| Rate for Payer: United Healthcare Medicaid |
$682.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$682.93
|
| Rate for Payer: Wellcare Medicare |
$636.78
|
|
|
HC IRIDOPLASTY BY PHOTOCOAGULTON 1>
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 66762
|
| Hospital Charge Code |
5106676201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.50
|
|
