|
HC REMOVE EYELID LESION
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 67840
|
| Hospital Charge Code |
5106784001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.82 |
| Max. Negotiated Rate |
$1,242.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,183.38
|
| Rate for Payer: Aetna Government |
$1,183.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$828.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$828.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$828.37
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.38
|
| 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 |
$1,183.38
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,053.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,053.21
|
| 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 |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$191.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$175.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.87
|
| Rate for Payer: Healthfirst QHP |
$1,183.38
|
| Rate for Payer: Humana Medicare |
$1,207.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,242.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,183.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,124.21
|
| Rate for Payer: Wellcare Medicare |
$1,124.21
|
|
|
HC REMOVE EYELID LESION MULTIPLE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
5106780501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.74 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$117.74
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.25
|
| 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 REMOVE EYELID LESION MULTIPLE
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 67805
|
| Hospital Charge Code |
5106780501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC REMOVE EYELID LESIONS
|
Facility
|
IP
|
$2,444.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
5106780101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,222.00 |
| Max. Negotiated Rate |
$1,222.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,222.00
|
|
|
HC REMOVE EYELID LESIONS
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 67801
|
| Hospital Charge Code |
5106780101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.89 |
| Max. Negotiated Rate |
$1,242.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,183.38
|
| Rate for Payer: Aetna Government |
$1,183.38
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$828.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$828.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$828.37
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,183.38
|
| 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 |
$1,183.38
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,065.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,005.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,053.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,183.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,053.21
|
| 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 |
$1,183.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$147.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,005.87
|
| Rate for Payer: Healthfirst QHP |
$1,183.38
|
| Rate for Payer: Humana Medicare |
$1,207.05
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,242.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,183.38
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,183.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,183.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,124.21
|
| Rate for Payer: Wellcare Medicare |
$1,124.21
|
|
|
HC REMOVE FOREARM/WRIST FOREIGN BODY
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
3612524801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
|
HC REMOVE FOREARM/WRIST FOREIGN BODY
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
3612524801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$502.37 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$3,226.50
|
| 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 |
$502.37
|
| 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 REMOVE FOREIGN BODY COMPLIC
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
3611012102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.43 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$212.43
|
| 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 |
$1,409.00
|
| 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 REMOVE FOREIGN BODY COMPLIC
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
3611012102
|
|
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 REMOVE FOREIGN BODY, CONJUNCTIVA, SUPERFICIAL
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
5106520501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.93 |
| 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 |
$31.93
|
| 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 REMOVE FOREIGN BODY, CONJUNCTIVA, SUPERFICIAL
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
5106520501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC REMOVE FOREIGN BODY EYE
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.56 |
| 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 |
$39.56
|
| 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 REMOVE FOREIGN BODY EYE
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 65210
|
| Hospital Charge Code |
5106521001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$550.50 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.50
|
|
|
HC REMOVE FOREIGN BODY - FOOT, SUBCUTANEOUS
|
Facility
|
OP
|
$1,823.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3612819001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$1,367.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| 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 |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| Rate for Payer: Group Health Inc Commercial |
$859.66
|
| Rate for Payer: Group Health Inc Medicare |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$158.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$151.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
|
HC REMOVE FOREIGN BODY - FOOT, SUBCUTANEOUS
|
Facility
|
IP
|
$1,823.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3612819001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$911.50 |
| Max. Negotiated Rate |
$911.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$911.50
|
|
|
HC REMOVE FOREIGN BODY, PHARYNX
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
4504280901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$874.00 |
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$487.56
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$487.56
|
| 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 |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$487.56
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| 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 |
$569.00
|
| 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 REMOVE FOREIGN BODY, PHARYNX
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 42809
|
| Hospital Charge Code |
4504280901
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$550.50 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.50
|
|
|
HC REMOVE FOREIGN BODY SIMPLE
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
3611012002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$483.50 |
| Max. Negotiated Rate |
$483.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$483.50
|
|
|
HC REMOVE FOREIGN BODY SIMPLE
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
3611012002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.86 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$488.15
|
| Rate for Payer: Aetna Government |
$488.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$341.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$341.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$341.70
|
| Rate for Payer: Brighton Health Commercial |
$725.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$488.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$488.15
|
| Rate for Payer: EmblemHealth Commercial |
$488.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$439.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$414.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$434.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$488.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$434.45
|
| Rate for Payer: Group Health Inc Commercial |
$488.15
|
| Rate for Payer: Group Health Inc Medicare |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$488.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$102.86
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$122.33
|
| 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 REMOVE FOREIGN BODY VESTIBULE MOUTH
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
4504080401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,202.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,145.53
|
| Rate for Payer: Aetna Government |
$1,145.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$801.87
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$801.87
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$801.87
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$1,145.53
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$1,145.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,145.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,145.53
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,030.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$973.70
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,019.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,145.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,019.52
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,145.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,145.53
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$1,145.53
|
| Rate for Payer: Humana Medicare |
$1,168.44
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,202.81
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,145.53
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,145.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,145.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,088.25
|
| Rate for Payer: Wellcare Medicare |
$1,088.25
|
|
|
HC REMOVE FOREIGN BODY VESTIBULE MOUTH
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT 40804
|
| Hospital Charge Code |
4504080401
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,190.00 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.00
|
|
|
HC REMOVE IMPL CONTRACEPTIVE CAPSULE
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
3611197601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$923.50 |
| Max. Negotiated Rate |
$923.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$923.50
|
|
|
HC REMOVE IMPL CONTRACEPTIVE CAPSULE
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
3611197601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$859.66
|
| Rate for Payer: Aetna Government |
$859.66
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$601.76
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$601.76
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$601.76
|
| Rate for Payer: Brighton Health Commercial |
$1,385.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$859.66
|
| 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 |
$859.66
|
| Rate for Payer: EmblemHealth Commercial |
$859.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$773.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$730.71
|
| Rate for Payer: Fidelis Essential Plan QHP |
$765.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$859.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$765.10
|
| Rate for Payer: Group Health Inc Commercial |
$859.66
|
| Rate for Payer: Group Health Inc Medicare |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$859.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$106.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$730.71
|
| Rate for Payer: Healthfirst QHP |
$859.66
|
| Rate for Payer: Humana Medicare |
$876.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$859.66
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$859.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$859.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$816.68
|
| Rate for Payer: Wellcare Medicare |
$816.68
|
|
|
HC REMOVE IRIS AND LESION
|
Facility
|
IP
|
$11,564.00
|
|
|
Service Code
|
CPT 66600
|
| Hospital Charge Code |
5106660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5,782.00 |
| Max. Negotiated Rate |
$5,782.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5,782.00
|
|
|
HC REMOVE IRIS AND LESION
|
Facility
|
OP
|
$11,564.00
|
|
|
Service Code
|
CPT 66600
|
| Hospital Charge Code |
5106660001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$5,160.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,915.21
|
| Rate for Payer: Aetna Government |
$4,915.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,440.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,440.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,440.65
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,915.21
|
| 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 |
$4,915.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,423.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4,177.93
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4,374.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,915.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,374.54
|
| 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 |
$4,915.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,094.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1,010.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$4,177.93
|
| Rate for Payer: Healthfirst QHP |
$4,915.21
|
| Rate for Payer: Humana Medicare |
$5,013.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5,160.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,915.21
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,915.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,915.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,669.45
|
| Rate for Payer: Wellcare Medicare |
$4,669.45
|
|
