|
HC REDUCTION OF TORSION OF TESTIS
|
Facility
|
IP
|
$9,142.00
|
|
|
Service Code
|
CPT 54600
|
| Hospital Charge Code |
3615460001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,571.00 |
| Max. Negotiated Rate |
$4,571.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,571.00
|
|
|
HC REFILL/MAINT, PORTABLE PUMP
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
2609652101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC REFILL/MAINT, PORTABLE PUMP
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96521
|
| Hospital Charge Code |
2609652101
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$444.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.43
|
| Rate for Payer: Aetna Government |
$257.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.20
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$444.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.43
|
| Rate for Payer: EmblemHealth Commercial |
$257.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$231.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$218.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$229.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$229.11
|
| Rate for Payer: Group Health Inc Commercial |
$257.43
|
| Rate for Payer: Group Health Inc Medicare |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$137.48
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.82
|
| Rate for Payer: Healthfirst QHP |
$257.43
|
| Rate for Payer: Humana Medicare |
$262.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.43
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$244.56
|
| Rate for Payer: Wellcare Medicare |
$244.56
|
|
|
HC REFILL/MAINT SYSTEMIC PUMP/RESVR
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
3359652201
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.00
|
|
|
HC REFILL/MAINT SYSTEMIC PUMP/RESVR
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 96522
|
| Hospital Charge Code |
3359652201
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$683.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$305.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$257.43
|
| Rate for Payer: Aetna Government |
$257.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$180.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$180.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$180.20
|
| Rate for Payer: Brighton Health Commercial |
$417.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$257.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$683.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$581.31
|
| Rate for Payer: Elderplan Medicare Advantage |
$257.43
|
| Rate for Payer: EmblemHealth Commercial |
$257.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$279.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$279.92
|
| Rate for Payer: Fidelis Essential Plan QHP |
$294.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$257.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$294.00
|
| Rate for Payer: Group Health Inc Commercial |
$257.43
|
| Rate for Payer: Group Health Inc Medicare |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$257.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$257.43
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$130.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$218.82
|
| Rate for Payer: Healthfirst QHP |
$257.43
|
| Rate for Payer: Humana Medicare |
$262.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$257.43
|
| Rate for Payer: United Healthcare Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$257.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$244.56
|
| Rate for Payer: Wellcare Medicare |
$244.56
|
|
|
HC REFOREARM TEND/MUSC,EXTEN,PRIM,EA
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
3612527001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$594.39 |
| Max. Negotiated Rate |
$6,695.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$6,695.25
|
| 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 |
$594.39
|
| 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 |
$1,835.00
|
| 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 REFOREARM TEND/MUSC,EXTEN,PRIM,EA
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
3612527001
|
|
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
|
|
|
HC REFOREARM TEND/MUSC,FLEX,PRIM,EA
|
Facility
|
IP
|
$8,927.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
3612526001
|
|
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
|
|
|
HC REFOREARM TEND/MUSC,FLEX,PRIM,EA
|
Facility
|
OP
|
$8,927.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
3612526001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$762.26 |
| Max. Negotiated Rate |
$6,695.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$6,695.25
|
| 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 |
$762.26
|
| 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 |
$1,835.00
|
| 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 REHABILITATION PROGRAM, PER 1/2 DAY
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT H2001
|
| Hospital Charge Code |
911H200101
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$114.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.50
|
|
|
HC REHABILITATION PROGRAM, PER 1/2 DAY
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT H2001
|
| Hospital Charge Code |
911H200101
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$183.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$125.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$59.00
|
| Rate for Payer: Aetna Government |
$59.00
|
| Rate for Payer: Brighton Health Commercial |
$171.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$183.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$155.72
|
| Rate for Payer: EmblemHealth Commercial |
$114.50
|
| Rate for Payer: Group Health Inc Commercial |
$114.50
|
| Rate for Payer: Group Health Inc Medicare |
$80.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$114.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$114.50
|
|
|
HC RELOCATION SKIN PICKET FOR DEBRIBILLATOR
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
3613322301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$475.82 |
| 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 |
$475.82
|
| 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 RELOCATION SKIN PICKET FOR DEBRIBILLATOR
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
3613322301
|
|
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 RELOCATION SKIN PICKET FOR PACEMAKER
|
Facility
|
OP
|
$4,914.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
3613322201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$401.05 |
| 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 |
$401.05
|
| 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 RELOCATION SKIN PICKET FOR PACEMAKER
|
Facility
|
IP
|
$4,914.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
3613322201
|
|
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 REMOTE 30 DAY ECG REV/REPORT - CARDIAC EVENT MONITOR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
7319327001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.00
|
|
|
HC REMOTE 30 DAY ECG REV/REPORT - CARDIAC EVENT MONITOR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
7319327001
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$61.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.56
|
| Rate for Payer: Aetna Government |
$45.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$31.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$31.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$31.89
|
| Rate for Payer: Brighton Health Commercial |
$84.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$45.56
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$89.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$76.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$45.56
|
| Rate for Payer: EmblemHealth Commercial |
$45.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$41.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$38.73
|
| Rate for Payer: Fidelis Essential Plan QHP |
$40.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$40.55
|
| Rate for Payer: Group Health Inc Commercial |
$45.56
|
| Rate for Payer: Group Health Inc Medicare |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$9.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$38.73
|
| Rate for Payer: Healthfirst QHP |
$45.56
|
| Rate for Payer: Humana Medicare |
$46.47
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$45.56
|
| Rate for Payer: United Healthcare Commercial |
$253.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$45.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.28
|
| Rate for Payer: Wellcare Medicare |
$43.28
|
|
|
HC REMOTE EVAL OF IMPLANT CARDIAC MON SYS, UP TO 30 DAYS
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT G2066
|
| Hospital Charge Code |
969G206601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.00
|
|
|
HC REMOTE EVAL OF IMPLANT CARDIAC MON SYS, UP TO 30 DAYS
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT G2066
|
| Hospital Charge Code |
969G206601
|
|
Hospital Revenue Code
|
969
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33.86
|
| Rate for Payer: Aetna Government |
$33.86
|
| Rate for Payer: Brighton Health Commercial |
$85.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$91.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$77.52
|
| Rate for Payer: EmblemHealth Commercial |
$57.00
|
| Rate for Payer: Group Health Inc Commercial |
$57.00
|
| Rate for Payer: Group Health Inc Medicare |
$39.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$57.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57.00
|
|
|
HC REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I
|
Facility
|
IP
|
$1,562.00
|
|
|
Service Code
|
CPT 47544 TC
|
| Hospital Charge Code |
3614754401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$781.00 |
| Max. Negotiated Rate |
$781.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$781.00
|
|
|
HC REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I
|
Facility
|
OP
|
$1,562.00
|
|
|
Service Code
|
CPT 47544 TC
|
| Hospital Charge Code |
3614754401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$546.70 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$933.68
|
| Rate for Payer: Aetna Government |
$933.68
|
| Rate for Payer: Brighton Health Commercial |
$1,171.50
|
| 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 |
$781.00
|
| Rate for Payer: Group Health Inc Commercial |
$781.00
|
| Rate for Payer: Group Health Inc Medicare |
$546.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$781.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$781.00
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC REMOVAL DEEP IMPLANT
|
Facility
|
IP
|
$7,747.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
3612068001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,873.50 |
| Max. Negotiated Rate |
$3,873.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,873.50
|
|
|
HC REMOVAL DEEP IMPLANT
|
Facility
|
OP
|
$7,747.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
3612068001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$494.50 |
| Max. Negotiated Rate |
$5,810.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,496.91
|
| Rate for Payer: Aetna Government |
$3,496.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,447.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,447.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,447.84
|
| Rate for Payer: Brighton Health Commercial |
$5,810.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,496.91
|
| 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 |
$3,496.91
|
| Rate for Payer: EmblemHealth Commercial |
$3,496.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,147.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,972.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,112.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,496.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,112.25
|
| Rate for Payer: Group Health Inc Commercial |
$3,496.91
|
| Rate for Payer: Group Health Inc Medicare |
$3,496.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,496.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,201.90
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$494.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,972.37
|
| Rate for Payer: Healthfirst QHP |
$3,496.91
|
| Rate for Payer: Humana Medicare |
$3,566.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,496.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,496.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,496.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,322.06
|
| Rate for Payer: Wellcare Medicare |
$3,322.06
|
|
|
HC REMOVAL EYELID, FOREIGN BODY
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
5106793801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.72 |
| Max. Negotiated Rate |
$383.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| 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 |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$160.11
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$128.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC REMOVAL EYELID, FOREIGN BODY
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 67938
|
| Hospital Charge Code |
5106793801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
