|
HC REMOVE NASAL FOREIGN BODY
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
3613030001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$110.24 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$247.50
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| 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 |
$140.99
|
| 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: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 NASAL FOREIGN BODY
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
3613030001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC REMOVE PERITONEAL FOREIGN BODY
|
Facility
|
IP
|
$9,417.00
|
|
|
Service Code
|
CPT 49402 TC
|
| Hospital Charge Code |
3614940201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,708.50 |
| Max. Negotiated Rate |
$4,708.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
|
|
HC REMOVE PERITONEAL FOREIGN BODY
|
Facility
|
OP
|
$9,417.00
|
|
|
Service Code
|
CPT 49402 TC
|
| Hospital Charge Code |
3614940201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,015.44 |
| Max. Negotiated Rate |
$7,062.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,015.44
|
| Rate for Payer: Aetna Government |
$1,015.44
|
| Rate for Payer: Brighton Health Commercial |
$7,062.75
|
| 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 |
$4,708.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,708.50
|
| Rate for Payer: Group Health Inc Medicare |
$3,295.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,685.17
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC REMOVE/REINSERT DRUG INPLANT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
3611198301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$550.50 |
| Max. Negotiated Rate |
$550.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$550.50
|
|
|
HC REMOVE/REINSERT DRUG INPLANT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 11983
|
| Hospital Charge Code |
3611198301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.81 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$825.75
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$487.56
|
| Rate for Payer: EmblemHealth Commercial |
$487.56
|
| 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 |
$487.56
|
| Rate for Payer: Group Health Inc Medicare |
$487.56
|
| 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 |
$119.81
|
| 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: Senior Whole Health Medicare Advantage |
$487.56
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 50389 TC
|
| Hospital Charge Code |
3615038901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$842.50 |
| Max. Negotiated Rate |
$842.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.50
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 50389 TC
|
| Hospital Charge Code |
3615038901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.93 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$364.98
|
| Rate for Payer: Aetna Government |
$364.98
|
| Rate for Payer: Brighton Health Commercial |
$1,263.75
|
| 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 |
$842.50
|
| Rate for Payer: Group Health Inc Commercial |
$842.50
|
| Rate for Payer: Group Health Inc Medicare |
$589.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$842.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$315.93
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 50384 TC
|
| Hospital Charge Code |
3615038401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$959.88 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,161.60
|
| Rate for Payer: Aetna Government |
$1,161.60
|
| Rate for Payer: Brighton Health Commercial |
$4,023.75
|
| 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 |
$2,682.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,682.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,877.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 50384 TC
|
| Hospital Charge Code |
3615038401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC REMOVSL TRANSVEN PACEMAKER ELCTRDE, DUAL LEAD
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
3613323401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$562.96 |
| 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 |
$562.96
|
| 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 REMOVSL TRANSVEN PACEMAKER ELCTRDE, DUAL LEAD
|
Facility
|
IP
|
$9,037.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
3613323401
|
|
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 REMV/BIVALING; GAUNLET, BOOT OR BODY CAST
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
5102970001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.63 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| 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 |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$292.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| 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 |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$340.71
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$308.27
|
|
|
HC REMV/BIVALING; GAUNLET, BOOT OR BODY CAST
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
5102970001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.00
|
|
|
HC REMV/BIVALING; GAUNLET, BOOT OR BODY CAST - PT
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
4202970001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$348.00 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.00
|
|
|
HC REMV/BIVALING; GAUNLET, BOOT OR BODY CAST - PT
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
4202970001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.63 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$324.49
|
| Rate for Payer: Aetna Government |
$324.49
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$227.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$227.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$227.14
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$324.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$324.49
|
| Rate for Payer: EmblemHealth Commercial |
$324.49
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$324.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$275.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$288.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$324.49
|
| Rate for Payer: Fidelis Qualified Health Plan |
$288.80
|
| Rate for Payer: Group Health Inc Commercial |
$324.49
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$324.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.34
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$38.63
|
| Rate for Payer: Healthfirst Medicare Advantage |
$275.82
|
| Rate for Payer: Healthfirst QHP |
$324.49
|
| Rate for Payer: Humana Medicare |
$330.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$324.49
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$324.49
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$308.27
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
HC REMV EXT CANAL F.B.,GEN ANESTH
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
5106920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$2,078.62 |
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,979.64
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$109.80
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,078.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,979.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 REMV EXT CANAL F.B.,GEN ANESTH
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 69205
|
| Hospital Charge Code |
5106920501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,078.50 |
| Max. Negotiated Rate |
$2,078.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,078.50
|
|
|
HC REMV EXT CANAL FOREIGN BODY
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
3616920001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
|
|
HC REMV EXT CANAL FOREIGN BODY
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.29 |
| 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 |
$55.29
|
| 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 REMV EXT CANAL FOREIGN BODY
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
3616920001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$55.29 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$304.50
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| 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 |
$55.29
|
| 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: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 REMV EXT CANAL FOREIGN BODY
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
5106920001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC REMV F.B.,EYE,SUPERF CONJUNC
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
3616520501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.93 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$304.50
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$157.49
|
| Rate for Payer: EmblemHealth Commercial |
$157.49
|
| 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 |
$157.49
|
| Rate for Payer: Group Health Inc Medicare |
$157.49
|
| 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: Senior Whole Health Medicare Advantage |
$157.49
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 REMV F.B.,EYE,SUPERF CONJUNC
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
3616520501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$203.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$203.00
|
|
|
HC REMV FOOT FOREIGN BODY,COMPLEX
|
Facility
|
OP
|
$4,157.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
3612819301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.82 |
| Max. Negotiated Rate |
$3,117.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$416.82
|
| 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
|
|
