|
HC REMOVAL FOREIGN BODY CORNEAL W/O SLIT LAMP
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5106522001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.09 |
| Max. Negotiated Rate |
$511.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$487.56
|
| Rate for Payer: Aetna Government |
$487.56
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.29
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.29
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.29
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$487.56
|
| 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 |
$487.56
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$438.80
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$433.93
|
| Rate for Payer: Fidelis Medicare Advantage |
$487.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$433.93
|
| 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 |
$487.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$487.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$46.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.43
|
| Rate for Payer: Healthfirst QHP |
$487.56
|
| Rate for Payer: Humana Medicare |
$497.31
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$511.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$487.56
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$487.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$487.56
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$463.18
|
| Rate for Payer: Wellcare Medicare |
$463.18
|
|
|
HC REMOVAL FOREIGN BODY CORNEAL W/O SLIT LAMP
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
5106522001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$550.50 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.50
|
|
|
HC REMOVAL FOREIGN BODY CORNEAL W/SLIT LAMP
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
5106522201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC REMOVAL FOREIGN BODY CORNEAL W/SLIT LAMP
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 65222
|
| Hospital Charge Code |
5106522201
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$157.49
|
| Rate for Payer: Aetna Government |
$157.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$110.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$110.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$110.24
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$141.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$133.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$140.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$157.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$140.17
|
| 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 |
$157.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$157.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$54.70
|
| Rate for Payer: Healthfirst Medicare Advantage |
$133.87
|
| Rate for Payer: Healthfirst QHP |
$157.49
|
| Rate for Payer: Humana Medicare |
$160.64
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$165.36
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$157.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$157.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$149.62
|
| Rate for Payer: Wellcare Medicare |
$149.62
|
|
|
HC REMOVAL FOREIGN BODY, DENTOVEOLAR, SOFT TISSUE
|
Facility
|
IP
|
$4,086.00
|
|
|
Service Code
|
CPT 41805
|
| Hospital Charge Code |
4504180501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,043.00 |
| Max. Negotiated Rate |
$2,043.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,043.00
|
|
|
HC REMOVAL FOREIGN BODY, DENTOVEOLAR, SOFT TISSUE
|
Facility
|
OP
|
$4,086.00
|
|
|
Service Code
|
CPT 41805
|
| Hospital Charge Code |
4504180501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,134.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,809.86
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$245.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,900.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC REMOVAL FOREIGN BODY MUSCLE, SIMPLE
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
3612052001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$141.35 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,979.64
|
| Rate for Payer: Aetna Government |
$1,979.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,385.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,385.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,385.75
|
| Rate for Payer: Brighton Health Commercial |
$3,117.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,979.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,979.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,781.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,682.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,761.88
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,979.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,761.88
|
| Rate for Payer: Group Health Inc Commercial |
$1,979.64
|
| Rate for Payer: Group Health Inc Medicare |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,979.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$141.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$173.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,682.69
|
| Rate for Payer: Healthfirst QHP |
$1,979.64
|
| Rate for Payer: Humana Medicare |
$2,019.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,979.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,979.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,880.66
|
| Rate for Payer: Wellcare Medicare |
$1,880.66
|
|
|
HC REMOVAL FOREIGN BODY MUSCLE, SIMPLE
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
3612052001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
5106921001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| 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 |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$36.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 69210
|
| Hospital Charge Code |
5106921001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$83.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$83.00
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5106920901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| 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 |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$76.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
5106920901
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$85.00
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
3616920901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.50
|
|
|
HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
3616920901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$18.47 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$72.58
|
| Rate for Payer: Aetna Government |
$72.58
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$50.81
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50.81
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$50.81
|
| Rate for Payer: Brighton Health Commercial |
$150.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$72.58
|
| 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 |
$72.58
|
| Rate for Payer: EmblemHealth Commercial |
$72.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$65.32
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$61.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$64.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$72.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$64.60
|
| Rate for Payer: Group Health Inc Commercial |
$72.58
|
| Rate for Payer: Group Health Inc Medicare |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$72.58
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.47
|
| Rate for Payer: Healthfirst Medicare Advantage |
$61.69
|
| Rate for Payer: Healthfirst QHP |
$72.58
|
| Rate for Payer: Humana Medicare |
$74.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$72.58
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$72.58
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$68.95
|
| Rate for Payer: Wellcare Medicare |
$68.95
|
|
|
HC REMOVAL IMP DEFRIB SYS, SING OR DUAL, TRANSVEN
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
3613324401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.78 |
| Max. Negotiated Rate |
$6,777.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,446.57
|
| Rate for Payer: Aetna Government |
$4,446.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,112.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,112.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,112.60
|
| Rate for Payer: Brighton Health Commercial |
$6,777.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,446.57
|
| 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 |
$4,446.57
|
| Rate for Payer: EmblemHealth Commercial |
$4,446.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,001.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,779.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,957.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,446.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,957.45
|
| Rate for Payer: Group Health Inc Commercial |
$4,446.57
|
| Rate for Payer: Group Health Inc Medicare |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,446.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,000.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,779.58
|
| Rate for Payer: Healthfirst QHP |
$4,446.57
|
| Rate for Payer: Humana Medicare |
$4,535.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,446.57
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,446.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,446.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,224.24
|
| Rate for Payer: Wellcare Medicare |
$4,224.24
|
|
|
HC REMOVAL IMP DEFRIB SYS, SING OR DUAL, TRANSVEN
|
Facility
|
IP
|
$9,037.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
3613324401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,518.50 |
| Max. Negotiated Rate |
$4,518.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,518.50
|
|
|
HC REMOVAL IMPL DEFRIB PULSE GEN ONLY
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
3613324101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.01 |
| Max. Negotiated Rate |
$6,777.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,446.57
|
| Rate for Payer: Aetna Government |
$4,446.57
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,112.60
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,112.60
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,112.60
|
| Rate for Payer: Brighton Health Commercial |
$6,777.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,446.57
|
| 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 |
$4,446.57
|
| Rate for Payer: EmblemHealth Commercial |
$4,446.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,001.91
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,779.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,957.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,446.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,957.45
|
| Rate for Payer: Group Health Inc Commercial |
$4,446.57
|
| Rate for Payer: Group Health Inc Medicare |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,446.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,953.83
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$251.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,779.58
|
| Rate for Payer: Healthfirst QHP |
$4,446.57
|
| Rate for Payer: Humana Medicare |
$4,535.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,446.57
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,446.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,446.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,224.24
|
| Rate for Payer: Wellcare Medicare |
$4,224.24
|
|
|
HC REMOVAL IMPL DEFRIB PULSE GEN ONLY
|
Facility
|
IP
|
$9,037.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
3613324101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,518.50 |
| Max. Negotiated Rate |
$4,518.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,518.50
|
|
|
HC REMOVAL OF CERCLAGE
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
3615987101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$161.07
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC REMOVAL OF CERCLAGE
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59871
|
| Hospital Charge Code |
3615987101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC REMOVAL OF EYE LESION
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 65420
|
| Hospital Charge Code |
5106542001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,992.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,850.46
|
| Rate for Payer: Aetna Government |
$2,850.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,995.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,995.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,995.32
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,850.46
|
| 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 |
$2,850.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,565.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,422.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,536.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,536.91
|
| 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 |
$2,850.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$429.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,422.89
|
| Rate for Payer: Healthfirst QHP |
$2,850.46
|
| Rate for Payer: Humana Medicare |
$2,907.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,992.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,850.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,850.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,850.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,707.94
|
| Rate for Payer: Wellcare Medicare |
$2,707.94
|
|
|
HC REMOVAL OF EYE LESION
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 65420
|
| Hospital Charge Code |
5106542001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,930.50 |
| Max. Negotiated Rate |
$2,930.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.50
|
|
|
HC REMOVAL OF FOREIGN BODY, ESOPHAGEAL W/ BALLOON CATH
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 74235 TC
|
| Hospital Charge Code |
3207423501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.00
|
|
|
HC REMOVAL OF FOREIGN BODY, ESOPHAGEAL W/ BALLOON CATH
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 74235 TC
|
| Hospital Charge Code |
3207423501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.05 |
| Max. Negotiated Rate |
$520.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$357.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.05
|
| Rate for Payer: Aetna Government |
$94.05
|
| Rate for Payer: Brighton Health Commercial |
$487.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$520.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$442.00
|
| Rate for Payer: EmblemHealth Commercial |
$325.00
|
| Rate for Payer: Group Health Inc Commercial |
$325.00
|
| Rate for Payer: Group Health Inc Medicare |
$227.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$325.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$325.00
|
| Rate for Payer: Healthfirst Essential Plan |
$294.48
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$130.88
|
|
|
HC REMOVAL OF IMPACTED TOOTH-COMPLET
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT D7240
|
| Hospital Charge Code |
361D724001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$412.50 |
| Max. Negotiated Rate |
$2,072.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$412.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,031.43
|
| Rate for Payer: Aetna Government |
$2,031.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,422.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,422.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,422.00
|
| Rate for Payer: Brighton Health Commercial |
$562.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,031.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$600.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$510.00
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,031.43
|
| Rate for Payer: EmblemHealth Commercial |
$2,031.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,828.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,726.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,807.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,031.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,807.97
|
| Rate for Payer: Group Health Inc Commercial |
$2,031.43
|
| Rate for Payer: Group Health Inc Medicare |
$2,031.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,031.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$892.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,726.72
|
| Rate for Payer: Healthfirst QHP |
$2,031.43
|
| Rate for Payer: Humana Medicare |
$2,072.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,031.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,031.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,031.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,929.86
|
| Rate for Payer: Wellcare Medicare |
$1,929.86
|
|
