|
HC PAIR OR CUT OF BENIGN HYPERKERATOTIC LESION, >4 LESIONS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
3611105701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC PAIR OR CUT OF BENIGN HYPERKERATOTIC LESION, >4 LESIONS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
3611105701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.69 |
| 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 |
$396.75
|
| 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 |
$63.72
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$30.69
|
| 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 PAIR OR CUT OF BENIGN HYPERKERATOTIC LESION, SINGLE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
3611105501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.02 |
| 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 |
$376.50
|
| 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 |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17.02
|
| 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 PAIR OR CUT OF BENIGN HYPERKERATOTIC LESION, SINGLE
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
3611105501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$251.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.00
|
|
|
HC PALB2 (PARTNER AND LOCALIZER OF BRCA2) FULL GENE SEQUENCE
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 81307
|
| Hospital Charge Code |
3108130701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$68.00
|
|
|
HC PALB2 (PARTNER AND LOCALIZER OF BRCA2) FULL GENE SEQUENCE
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 81307
|
| Hospital Charge Code |
3108130701
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$690.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$74.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$676.50
|
| Rate for Payer: Aetna Government |
$676.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$473.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$473.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$473.55
|
| Rate for Payer: Brighton Health Commercial |
$676.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$676.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$108.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$92.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$676.50
|
| Rate for Payer: EmblemHealth Commercial |
$676.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$608.85
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$575.02
|
| Rate for Payer: Fidelis Essential Plan QHP |
$602.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$676.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$602.09
|
| Rate for Payer: Group Health Inc Commercial |
$676.50
|
| Rate for Payer: Group Health Inc Medicare |
$676.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$676.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$676.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$676.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$676.50
|
| Rate for Payer: Healthfirst QHP |
$676.50
|
| Rate for Payer: Humana Medicare |
$690.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$676.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$676.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$676.50
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$642.67
|
| Rate for Payer: Wellcare Medicare |
$608.85
|
|
|
HC PANCREATIC CANCER PANEL
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3008147901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.00
|
|
|
HC PANCREATIC CANCER PANEL
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3008147901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$171.00
|
| Rate for Payer: Aetna Government |
$171.00
|
| Rate for Payer: Brighton Health Commercial |
$256.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$273.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$232.56
|
| Rate for Payer: EmblemHealth Commercial |
$171.00
|
| Rate for Payer: Group Health Inc Commercial |
$171.00
|
| Rate for Payer: Group Health Inc Medicare |
$119.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$171.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$171.00
|
|
|
HC PANCREATIC ELASTASE, FECAL, QUAL/SEMI-QUANT - PANCREATIC ELASTASE
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
3018265601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.00
|
|
|
HC PANCREATIC ELASTASE, FECAL, QUAL/SEMI-QUANT - PANCREATIC ELASTASE
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
3018265601
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.53
|
| Rate for Payer: Aetna Government |
$11.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8.07
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8.07
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8.07
|
| Rate for Payer: Brighton Health Commercial |
$21.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.51
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.53
|
| Rate for Payer: EmblemHealth Commercial |
$11.53
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.38
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.80
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$11.53
|
| Rate for Payer: Group Health Inc Medicare |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.53
|
| Rate for Payer: Healthfirst QHP |
$11.53
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare Commercial |
$14.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$10.38
|
|
|
HC PANORAMIC FILM
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT D0330
|
| Hospital Charge Code |
361D033001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.50 |
| Max. Negotiated Rate |
$43.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.50
|
|
|
HC PANORAMIC FILM
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT D0330
|
| Hospital Charge Code |
361D033001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$47.85 |
| Max. Negotiated Rate |
$301.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$295.34
|
| Rate for Payer: Aetna Government |
$295.34
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$206.74
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$206.74
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$206.74
|
| Rate for Payer: Brighton Health Commercial |
$65.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$295.34
|
| 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 |
$295.34
|
| Rate for Payer: EmblemHealth Commercial |
$295.34
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$265.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$251.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$262.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$295.34
|
| Rate for Payer: Fidelis Qualified Health Plan |
$262.85
|
| Rate for Payer: Group Health Inc Commercial |
$295.34
|
| Rate for Payer: Group Health Inc Medicare |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$295.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$295.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$251.04
|
| Rate for Payer: Healthfirst QHP |
$295.34
|
| Rate for Payer: Humana Medicare |
$301.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$295.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$295.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$295.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$280.57
|
| Rate for Payer: Wellcare Medicare |
$280.57
|
|
|
HC PARAINFLUENZA AG
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
3068727901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.11 |
| Max. Negotiated Rate |
$30.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.43
|
| Rate for Payer: Aetna Government |
$16.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$11.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$11.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$11.50
|
| Rate for Payer: Brighton Health Commercial |
$30.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$16.43
|
| Rate for Payer: EmblemHealth Commercial |
$16.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$14.79
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$13.97
|
| Rate for Payer: Fidelis Essential Plan QHP |
$14.62
|
| Rate for Payer: Fidelis Medicare Advantage |
$16.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$14.62
|
| Rate for Payer: Group Health Inc Commercial |
$16.43
|
| Rate for Payer: Group Health Inc Medicare |
$16.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Healthfirst Essential Plan |
$18.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16.43
|
| Rate for Payer: Healthfirst QHP |
$16.43
|
| Rate for Payer: Humana Medicare |
$16.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16.43
|
| Rate for Payer: United Healthcare Commercial |
$15.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.11
|
| Rate for Payer: Wellcare Medicare |
$14.79
|
|
|
HC PARAINFLUENZA AG
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 87279
|
| Hospital Charge Code |
3068727901
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20.50
|
|
|
HC PARATHYROID PLANAR IMAGING - NM PARATHYROID
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 78070 TC
|
| Hospital Charge Code |
3417807001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$106.70 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$612.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$178.81
|
| Rate for Payer: Aetna Government |
$178.81
|
| Rate for Payer: Brighton Health Commercial |
$835.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$469.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$395.37
|
| Rate for Payer: EmblemHealth Commercial |
$239.08
|
| Rate for Payer: Group Health Inc Commercial |
$557.00
|
| Rate for Payer: Group Health Inc Medicare |
$389.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$557.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$239.08
|
| Rate for Payer: Healthfirst Essential Plan |
$240.07
|
| Rate for Payer: United Healthcare Commercial |
$175.59
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$106.70
|
|
|
HC PARATHYROID PLANAR IMAGING - NM PARATHYROID
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 78070 TC
|
| Hospital Charge Code |
3417807001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$557.00 |
| Max. Negotiated Rate |
$557.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$557.00
|
|
|
HC PARTAIL EXCISION BONE, TIBIA
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 27648 TC
|
| Hospital Charge Code |
3612764801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$166.14
|
| Rate for Payer: Aetna Government |
$166.14
|
| Rate for Payer: Brighton Health Commercial |
$335.25
|
| 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 |
$223.50
|
| Rate for Payer: Group Health Inc Commercial |
$223.50
|
| Rate for Payer: Group Health Inc Medicare |
$156.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$223.50
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC PARTAIL EXCISION BONE, TIBIA
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 27648 TC
|
| Hospital Charge Code |
3612764801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$223.50 |
| Max. Negotiated Rate |
$223.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$223.50
|
|
|
HC PARTIAL AMPUTATION TOE
|
Facility
|
OP
|
$8,291.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
3612882501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.92 |
| Max. Negotiated Rate |
$6,218.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,964.33
|
| Rate for Payer: Aetna Government |
$3,964.33
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,775.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,775.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,775.03
|
| Rate for Payer: Brighton Health Commercial |
$6,218.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,964.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$3,964.33
|
| Rate for Payer: EmblemHealth Commercial |
$3,964.33
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,567.90
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,369.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,528.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,964.33
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,528.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,964.33
|
| Rate for Payer: Group Health Inc Medicare |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,964.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,579.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$195.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,369.68
|
| Rate for Payer: Healthfirst QHP |
$3,964.33
|
| Rate for Payer: Humana Medicare |
$4,043.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,964.33
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,964.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,964.33
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,766.11
|
| Rate for Payer: Wellcare Medicare |
$3,766.11
|
|
|
HC PARTIAL AMPUTATION TOE
|
Facility
|
IP
|
$8,291.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
3612882501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,145.50 |
| Max. Negotiated Rate |
$4,145.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.50
|
|
|
HC PARTIAL EXCISN BONE, DISTAL PHALANX FINGER
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
3612623601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,052.50 |
| Max. Negotiated Rate |
$2,052.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,052.50
|
|
|
HC PARTIAL EXCISN BONE, DISTAL PHALANX FINGER
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
3612623601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$532.01 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,955.41
|
| Rate for Payer: Aetna Government |
$1,955.41
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,368.79
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,368.79
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,368.79
|
| Rate for Payer: Brighton Health Commercial |
$3,078.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,955.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,955.41
|
| Rate for Payer: EmblemHealth Commercial |
$1,955.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,759.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,662.10
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,740.31
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,955.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,740.31
|
| Rate for Payer: Group Health Inc Commercial |
$1,955.41
|
| Rate for Payer: Group Health Inc Medicare |
$1,955.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,955.41
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$838.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$532.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,662.10
|
| Rate for Payer: Healthfirst QHP |
$1,955.41
|
| Rate for Payer: Humana Medicare |
$1,994.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,955.41
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,955.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,955.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,857.64
|
| Rate for Payer: Wellcare Medicare |
$1,857.64
|
|
|
HC PARTIAL REMOVAL OF EYE FLUID
|
Facility
|
IP
|
$6,123.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
5106700501
|
|
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 PARTIAL REMOVAL OF EYE FLUID
|
Facility
|
OP
|
$6,123.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
5106700501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,925.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$537.67
|
| 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 PARTIAL REMOVAL OF TOE, PHALANX
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
3612812401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,463.50 |
| Max. Negotiated Rate |
$4,463.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,463.50
|
|
