|
HC REMOVAL OF IMPACTED TOOTH-COMPLET
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT D7240
|
| Hospital Charge Code |
361D724001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$375.00 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$375.00
|
|
|
HC REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Facility
|
OP
|
$9,354.00
|
|
|
Service Code
|
CPT 36262
|
| Hospital Charge Code |
3613626201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.60 |
| Max. Negotiated Rate |
$7,015.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$7,015.50
|
| 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 |
$378.60
|
| 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 OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Facility
|
IP
|
$9,354.00
|
|
|
Service Code
|
CPT 36262
|
| Hospital Charge Code |
3613626201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,677.00 |
| Max. Negotiated Rate |
$4,677.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,677.00
|
|
|
HC REMOVAL OF IMPLANT, SUPERFICIAL
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
3612067001
|
|
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 OF IMPLANT, SUPERFICIAL
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
3612067001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$170.19 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$708.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$170.19
|
| 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 |
$1,409.00
|
| 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 OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 32552 TC
|
| Hospital Charge Code |
3613255201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.06 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.06
|
| Rate for Payer: Aetna Government |
$196.06
|
| Rate for Payer: Brighton Health Commercial |
$1,431.75
|
| 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 |
$954.50
|
| Rate for Payer: Group Health Inc Commercial |
$954.50
|
| Rate for Payer: Group Health Inc Medicare |
$668.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$332.31
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 32552 TC
|
| Hospital Charge Code |
3613255201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC REMOVAL OF IUD
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
3615830101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$407.00 |
| Max. Negotiated Rate |
$407.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$407.00
|
|
|
HC REMOVAL OF IUD
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 58301
|
| Hospital Charge Code |
3615830101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$58.22 |
| Max. Negotiated Rate |
$21,008.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$371.67
|
| Rate for Payer: Aetna Government |
$371.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$472.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$472.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$210.08
|
| Rate for Payer: Amida Care Medicaid |
$210.08
|
| Rate for Payer: Brighton Health Commercial |
$610.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$371.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$371.67
|
| Rate for Payer: EmblemHealth Commercial |
$371.67
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$472.68
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$210.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$210.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$472.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$472.68
|
| Rate for Payer: Fidelis Medicare Advantage |
$371.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.58
|
| Rate for Payer: Group Health Inc Commercial |
$371.67
|
| Rate for Payer: Group Health Inc Medicare |
$371.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$210.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,008.00
|
| Rate for Payer: Healthfirst Essential Plan |
$472.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$315.92
|
| Rate for Payer: Healthfirst QHP |
$342.43
|
| Rate for Payer: Humana Medicare |
$379.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$371.67
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$210.08
|
| Rate for Payer: SOMOS Essential |
$472.68
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$472.68
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$231.09
|
| Rate for Payer: United Healthcare Medicaid |
$210.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$371.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$371.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$210.08
|
| Rate for Payer: Wellcare Medicare |
$353.09
|
|
|
HC REMOVAL OF LESION/TENDON/CAPSULE, FOOT
|
Facility
|
IP
|
$4,105.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
3612809001
|
|
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 REMOVAL OF LESION/TENDON/CAPSULE, FOOT
|
Facility
|
OP
|
$4,105.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
3612809001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.21 |
| 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 |
$358.21
|
| 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 |
$1,468.00
|
| 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 REMOVAL OF NAIL BED
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
3611175002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$99.95 |
| 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 |
$99.95
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$115.25
|
| 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 REMOVAL OF NAIL BED
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
3611175002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC REMOVAL OF NAIL PLATE
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
3611173002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$59.75 |
| 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 |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$59.75
|
| 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 REMOVAL OF NAIL PLATE
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
3611173002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC REMOVAL OF SALIVARY STONE
|
Facility
|
OP
|
$8,294.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
4504233001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$4,160.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,962.45
|
| Rate for Payer: Aetna Government |
$3,962.45
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,773.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,773.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,773.72
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,962.45
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,962.45
|
| 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 |
$3,962.45
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,566.20
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,368.08
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,526.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,962.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,526.58
|
| 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 |
$3,962.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$144.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,962.45
|
| Rate for Payer: Humana Medicare |
$4,041.70
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,160.57
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,962.45
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,962.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,962.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,764.33
|
| Rate for Payer: Wellcare Medicare |
$3,764.33
|
|
|
HC REMOVAL OF SALIVARY STONE
|
Facility
|
IP
|
$8,294.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
4504233001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,147.00 |
| Max. Negotiated Rate |
$4,147.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,147.00
|
|
|
HC REMOVAL OF SKIN TAGS, <15 LESIONS
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
3611120001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$264.50 |
| Max. Negotiated Rate |
$264.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$264.50
|
|
|
HC REMOVAL OF SKIN TAGS, <15 LESIONS
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
3611120001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$88.70 |
| 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 |
$242.78
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$88.70
|
| 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 REMOVAL OF SKIN TAGS, ADD'L 10 LESIONS (ADDON)
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
3611120101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.50
|
|
|
HC REMOVAL OF SKIN TAGS, ADD'L 10 LESIONS (ADDON)
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 11201
|
| Hospital Charge Code |
3611120101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.40
|
| Rate for Payer: Aetna Government |
$14.40
|
| Rate for Payer: Brighton Health Commercial |
$267.75
|
| 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 |
$178.50
|
| Rate for Payer: Group Health Inc Commercial |
$178.50
|
| Rate for Payer: Group Health Inc Medicare |
$124.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$178.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$178.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.06
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC REMOVAL OF SUTURES AND STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
3611585401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$228.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.50
|
|
|
HC REMOVAL OF SUTURES AND STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 15854
|
| Hospital Charge Code |
3611585401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$251.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$228.50
|
| Rate for Payer: Aetna Government |
$228.50
|
| Rate for Payer: Brighton Health Commercial |
$342.75
|
| 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 |
$228.50
|
| Rate for Payer: Group Health Inc Commercial |
$228.50
|
| Rate for Payer: Group Health Inc Medicare |
$159.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$16.92
|
|
|
HC REMOVAL OF SUTURES OR STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
3611585301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$228.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.50
|
|
|
HC REMOVAL OF SUTURES OR STAPLES NOT REQUIRING ANESTHESIA
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 15853
|
| Hospital Charge Code |
3611585301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$13.43 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$251.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$228.50
|
| Rate for Payer: Aetna Government |
$228.50
|
| Rate for Payer: Brighton Health Commercial |
$342.75
|
| 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 |
$228.50
|
| Rate for Payer: Group Health Inc Commercial |
$228.50
|
| Rate for Payer: Group Health Inc Medicare |
$159.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$228.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$228.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$13.43
|
|
