|
HC REMV FOOT FOREIGN BODY,COMPLEX
|
Facility
|
IP
|
$4,157.00
|
|
|
Service Code
|
CPT 28193
|
| Hospital Charge Code |
3612819301
|
|
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 REMV FOOT FOREIGN BODY,DEEP
|
Facility
|
OP
|
$4,497.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
3612819201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.92 |
| Max. Negotiated Rate |
$3,372.75 |
| 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 |
$3,372.75
|
| 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 |
$358.92
|
| 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 REMV FOOT FOREIGN BODY,DEEP
|
Facility
|
IP
|
$4,497.00
|
|
|
Service Code
|
CPT 28192
|
| Hospital Charge Code |
3612819201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,248.50 |
| Max. Negotiated Rate |
$2,248.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,248.50
|
|
|
HC REMVL PERM PULSE GEN DUAL LEAD
|
Facility
|
OP
|
$30,076.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3613322801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$413.22 |
| Max. Negotiated Rate |
$22,557.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12,786.75
|
| Rate for Payer: Aetna Government |
$12,786.75
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,950.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,950.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,950.73
|
| Rate for Payer: Brighton Health Commercial |
$22,557.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12,786.75
|
| 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: Elderplan Medicare Advantage |
$12,786.75
|
| Rate for Payer: EmblemHealth Commercial |
$12,786.75
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11,508.08
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,868.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11,380.21
|
| Rate for Payer: Fidelis Medicare Advantage |
$12,786.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11,380.21
|
| Rate for Payer: Group Health Inc Commercial |
$12,786.75
|
| Rate for Payer: Group Health Inc Medicare |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,786.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,531.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$413.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,868.74
|
| Rate for Payer: Healthfirst QHP |
$12,786.75
|
| Rate for Payer: Humana Medicare |
$13,042.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12,786.75
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,786.75
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12,786.75
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12,147.41
|
| Rate for Payer: Wellcare Medicare |
$12,147.41
|
|
|
HC REMVL PERM PULSE GEN DUAL LEAD
|
Facility
|
IP
|
$30,076.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3613322801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,038.00 |
| Max. Negotiated Rate |
$15,038.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,038.00
|
|
|
HC REMVL PERM PULSE GEN MULTI LEAD
|
Facility
|
IP
|
$55,466.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
3613322901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$27,733.00 |
| Max. Negotiated Rate |
$27,733.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,733.00
|
|
|
HC REMVL PERM PULSE GEN MULTI LEAD
|
Facility
|
OP
|
$55,466.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
3613322901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.75 |
| Max. Negotiated Rate |
$41,599.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16,751.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,301.52
|
| Rate for Payer: Aetna Government |
$23,301.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$16,311.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$16,311.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$16,311.06
|
| Rate for Payer: Brighton Health Commercial |
$41,599.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,301.52
|
| 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 |
$23,301.52
|
| Rate for Payer: EmblemHealth Commercial |
$23,301.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,971.37
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$19,806.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$20,738.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,301.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$20,738.35
|
| Rate for Payer: Group Health Inc Commercial |
$23,301.52
|
| Rate for Payer: Group Health Inc Medicare |
$23,301.52
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,301.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13,222.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$432.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$19,806.29
|
| Rate for Payer: Healthfirst QHP |
$23,301.52
|
| Rate for Payer: Humana Medicare |
$23,767.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,301.52
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,301.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,301.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,136.44
|
| Rate for Payer: Wellcare Medicare |
$22,136.44
|
|
|
HC REMVL PERM PULSE GEN SNGL LEAD
|
Facility
|
OP
|
$23,145.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
3613322701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$394.31 |
| Max. Negotiated Rate |
$17,358.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10,111.76
|
| Rate for Payer: Aetna Government |
$10,111.76
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$7,078.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$7,078.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$7,078.23
|
| Rate for Payer: Brighton Health Commercial |
$17,358.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$10,111.76
|
| 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 |
$10,111.76
|
| Rate for Payer: EmblemHealth Commercial |
$10,111.76
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$9,100.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$8,595.00
|
| Rate for Payer: Fidelis Essential Plan QHP |
$8,999.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$10,111.76
|
| Rate for Payer: Fidelis Qualified Health Plan |
$8,999.47
|
| Rate for Payer: Group Health Inc Commercial |
$10,111.76
|
| Rate for Payer: Group Health Inc Medicare |
$10,111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10,111.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,423.59
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$394.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,595.00
|
| Rate for Payer: Healthfirst QHP |
$10,111.76
|
| Rate for Payer: Humana Medicare |
$10,314.00
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$10,111.76
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,111.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$10,111.76
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,606.17
|
| Rate for Payer: Wellcare Medicare |
$9,606.17
|
|
|
HC REMVL PERM PULSE GEN SNGL LEAD
|
Facility
|
IP
|
$23,145.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
3613322701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,572.50 |
| Max. Negotiated Rate |
$11,572.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,572.50
|
|
|
HC REMV/REVISN FULL ARM/LEG CAST
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
5102970501
|
|
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/REVISN FULL ARM/LEG CAST
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
5102970501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.93 |
| 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 |
$34.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.46
|
| 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 RENAL ENDOSCOPY W/URETERAL CATH
|
Facility
|
OP
|
$12,816.00
|
|
|
Service Code
|
CPT 50553 TC
|
| Hospital Charge Code |
3615055301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$464.18 |
| Max. Negotiated Rate |
$9,612.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$464.18
|
| Rate for Payer: Aetna Government |
$464.18
|
| Rate for Payer: Brighton Health Commercial |
$9,612.00
|
| 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 |
$6,408.00
|
| Rate for Payer: Group Health Inc Commercial |
$6,408.00
|
| Rate for Payer: Group Health Inc Medicare |
$4,485.60
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,521.60
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
|
|
HC RENAL ENDOSCOPY W/URETERAL CATH
|
Facility
|
IP
|
$12,816.00
|
|
|
Service Code
|
CPT 50553 TC
|
| Hospital Charge Code |
3615055301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,408.00 |
| Max. Negotiated Rate |
$6,408.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,408.00
|
|
|
HC RENAL FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
3018006901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$42.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.68
|
| Rate for Payer: Aetna Government |
$8.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$6.08
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$6.08
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$6.08
|
| Rate for Payer: Brighton Health Commercial |
$58.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.43
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.68
|
| Rate for Payer: EmblemHealth Commercial |
$8.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$7.81
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$7.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.73
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.73
|
| Rate for Payer: Group Health Inc Commercial |
$8.68
|
| Rate for Payer: Group Health Inc Medicare |
$8.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.68
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$8.68
|
| Rate for Payer: Healthfirst Essential Plan |
$19.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.68
|
| Rate for Payer: Healthfirst QHP |
$8.68
|
| Rate for Payer: Humana Medicare |
$8.85
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.68
|
| Rate for Payer: United Healthcare Commercial |
$11.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$8.68
|
| Rate for Payer: Wellcare Medicare |
$7.81
|
|
|
HC RENAL FUNCTION PANEL - BUNDLED CHARGE
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
3018006901
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.00
|
|
|
HC REPAIR ANEURYSM , PSEUDOANEU & OCCL DIS, ABDOMINAL AORTA
|
Facility
|
OP
|
$5,313.00
|
|
|
Service Code
|
CPT 35081 TC
|
| Hospital Charge Code |
3613508101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,984.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,922.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,991.25
|
| Rate for Payer: Aetna Government |
$1,991.25
|
| Rate for Payer: Brighton Health Commercial |
$3,984.75
|
| 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 |
$2,656.50
|
| Rate for Payer: Group Health Inc Commercial |
$2,656.50
|
| Rate for Payer: Group Health Inc Medicare |
$1,859.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,656.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,656.50
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
HC REPAIR ANEURYSM , PSEUDOANEU & OCCL DIS, ABDOMINAL AORTA
|
Facility
|
IP
|
$5,313.00
|
|
|
Service Code
|
CPT 35081 TC
|
| Hospital Charge Code |
3613508101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,656.50 |
| Max. Negotiated Rate |
$2,656.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,656.50
|
|
|
HC REPAIR ARTERIOVENOUS FISTULA EXTREMITIES
|
Facility
|
OP
|
$13,920.00
|
|
|
Service Code
|
CPT 35190
|
| Hospital Charge Code |
3613519001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$881.56 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,604.79
|
| Rate for Payer: Aetna Government |
$6,604.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,623.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,623.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,623.35
|
| Rate for Payer: Brighton Health Commercial |
$10,440.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,604.79
|
| 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 |
$6,604.79
|
| Rate for Payer: EmblemHealth Commercial |
$6,604.79
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,944.31
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,614.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,878.26
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,604.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,878.26
|
| Rate for Payer: Group Health Inc Commercial |
$6,604.79
|
| Rate for Payer: Group Health Inc Medicare |
$6,604.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,604.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,604.79
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$881.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,614.07
|
| Rate for Payer: Healthfirst QHP |
$6,604.79
|
| Rate for Payer: Humana Medicare |
$6,736.89
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,604.79
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,604.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,604.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6,274.55
|
| Rate for Payer: Wellcare Medicare |
$6,274.55
|
|
|
HC REPAIR ARTERIOVENOUS FISTULA EXTREMITIES
|
Facility
|
IP
|
$13,920.00
|
|
|
Service Code
|
CPT 35190
|
| Hospital Charge Code |
3613519001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,960.00 |
| Max. Negotiated Rate |
$6,960.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6,960.00
|
|
|
HC REPAIR CORNEA LAC,APPLY GLUE
|
Facility
|
OP
|
$6,476.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
3616528601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.47 |
| Max. Negotiated Rate |
$4,857.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,786.64
|
| Rate for Payer: Aetna Government |
$2,786.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,950.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,950.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,950.65
|
| Rate for Payer: Brighton Health Commercial |
$4,857.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,786.64
|
| 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 |
$2,786.64
|
| Rate for Payer: EmblemHealth Commercial |
$2,786.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,507.98
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,368.64
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,480.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,786.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,480.11
|
| Rate for Payer: Group Health Inc Commercial |
$2,786.64
|
| Rate for Payer: Group Health Inc Medicare |
$2,786.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,786.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$432.47
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$552.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,368.64
|
| Rate for Payer: Healthfirst QHP |
$2,786.64
|
| Rate for Payer: Humana Medicare |
$2,842.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,786.64
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,786.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,786.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,647.31
|
| Rate for Payer: Wellcare Medicare |
$2,647.31
|
|
|
HC REPAIR CORNEA LAC,APPLY GLUE
|
Facility
|
IP
|
$6,476.00
|
|
|
Service Code
|
CPT 65286
|
| Hospital Charge Code |
3616528601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,238.00 |
| Max. Negotiated Rate |
$3,238.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,238.00
|
|
|
HC REPAIR CV CATH W/O SUBQ PORT OR PUMP
|
Facility
|
OP
|
$1,909.00
|
|
|
Service Code
|
CPT 36575 TC
|
| Hospital Charge Code |
3613657501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38.03
|
| Rate for Payer: Aetna Government |
$38.03
|
| 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 REPAIR CV CATH W/O SUBQ PORT OR PUMP
|
Facility
|
IP
|
$1,909.00
|
|
|
Service Code
|
CPT 36575 TC
|
| Hospital Charge Code |
3613657501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$954.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$954.50
|
|
|
HC REPAIR CV CATH W SUBQ PORT OR PUMP
|
Facility
|
IP
|
$4,328.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
3613657601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,164.00 |
| Max. Negotiated Rate |
$2,164.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,164.00
|
|
|
HC REPAIR CV CATH W SUBQ PORT OR PUMP
|
Facility
|
OP
|
$4,328.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
3613657601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$3,246.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,898.02
|
| Rate for Payer: Aetna Government |
$1,898.02
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,328.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,328.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,328.61
|
| Rate for Payer: Brighton Health Commercial |
$3,246.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,898.02
|
| 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 |
$1,898.02
|
| Rate for Payer: EmblemHealth Commercial |
$1,898.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,708.22
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,613.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,689.24
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,898.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,689.24
|
| Rate for Payer: Group Health Inc Commercial |
$1,898.02
|
| Rate for Payer: Group Health Inc Medicare |
$1,898.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,898.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$210.75
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,613.32
|
| Rate for Payer: Healthfirst QHP |
$1,898.02
|
| Rate for Payer: Humana Medicare |
$1,935.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,898.02
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,898.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,898.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,803.12
|
| Rate for Payer: Wellcare Medicare |
$1,803.12
|
|
