|
HC REPAIR DETACHED RETINA
|
Facility
|
IP
|
$6,123.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
5106711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,061.50 |
| Max. Negotiated Rate |
$3,061.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,061.50
|
|
|
HC REPAIR DETACHED RETINA
|
Facility
|
OP
|
$6,123.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
5106711001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,925.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,786.64
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,786.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$493.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$908.71
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,925.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,786.64
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 DETACHED RETINA
|
Facility
|
OP
|
$11,564.00
|
|
|
Service Code
|
CPT 67108
|
| Hospital Charge Code |
5106710801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$5,160.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| 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 |
$1,321.78
|
| 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
|
|
|
HC REPAIR DETACHED RETINA
|
Facility
|
IP
|
$11,564.00
|
|
|
Service Code
|
CPT 67108
|
| Hospital Charge Code |
5106710801
|
|
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 REPAIR DETACHED RETINA BY INJECTION
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
5106790401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,930.50 |
| Max. Negotiated Rate |
$2,930.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.50
|
|
|
HC REPAIR DETACHED RETINA BY INJECTION
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 67904
|
| Hospital Charge Code |
5106790401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,992.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,850.46
|
| Rate for Payer: Aetna Government |
$2,850.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,995.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,995.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,995.32
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,850.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,850.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,565.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,422.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,536.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,536.91
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,026.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$667.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,422.89
|
| Rate for Payer: Healthfirst QHP |
$2,850.46
|
| Rate for Payer: Humana Medicare |
$2,907.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,992.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,850.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,850.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,850.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,707.94
|
| Rate for Payer: Wellcare Medicare |
$2,707.94
|
|
|
HC REPAIR DETACHED RETINA PC
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
3616710501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$763.50 |
| Max. Negotiated Rate |
$763.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$763.50
|
|
|
HC REPAIR DETACHED RETINA PC
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
3616710501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.26 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$670.29
|
| Rate for Payer: Aetna Government |
$670.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$469.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$469.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$469.20
|
| Rate for Payer: Brighton Health Commercial |
$1,145.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$670.29
|
| 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 |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$670.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$603.26
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$569.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$596.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$670.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$596.56
|
| Rate for Payer: Group Health Inc Commercial |
$670.29
|
| Rate for Payer: Group Health Inc Medicare |
$670.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$670.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$166.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$308.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$569.75
|
| Rate for Payer: Healthfirst QHP |
$670.29
|
| Rate for Payer: Humana Medicare |
$683.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$670.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$670.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$636.78
|
| Rate for Payer: Wellcare Medicare |
$636.78
|
|
|
HC REPAIR DUCT OPENING
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 68760
|
| Hospital Charge Code |
3616876001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$409.50 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$409.50
|
|
|
HC REPAIR DUCT OPENING
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 68760
|
| Hospital Charge Code |
3616876001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$146.21 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$614.25
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$365.24
|
| 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 |
$365.24
|
| Rate for Payer: Group Health Inc Medicare |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$146.21
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.30
|
| 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: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| 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 REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Facility
|
OP
|
$4,302.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
3612641801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$733.03 |
| Max. Negotiated Rate |
$3,226.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$733.03
|
| 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 |
$1,409.00
|
| 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 REPAIR EXTEN TENDON,DORSUM FINGR,EA
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
3612641801
|
|
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 REPAIR EYELID, WOUND
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
5106793001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.48 |
| Max. Negotiated Rate |
$2,992.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,850.46
|
| Rate for Payer: Aetna Government |
$2,850.46
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,995.32
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,995.32
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,995.32
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,850.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,850.46
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,565.41
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,422.89
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,536.91
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,850.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,536.91
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,850.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$226.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.36
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,422.89
|
| Rate for Payer: Healthfirst QHP |
$2,850.46
|
| Rate for Payer: Humana Medicare |
$2,907.47
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2,992.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,850.46
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,850.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,850.46
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,707.94
|
| Rate for Payer: Wellcare Medicare |
$2,707.94
|
|
|
HC REPAIR EYELID, WOUND
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 67930
|
| Hospital Charge Code |
5106793001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,930.50 |
| Max. Negotiated Rate |
$2,930.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,930.50
|
|
|
HC REPAIR INCISIONAL HERNIA,INCAR/STRANG
|
Facility
|
IP
|
$9,417.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
4504956101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,708.50 |
| Max. Negotiated Rate |
$4,708.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,708.50
|
|
|
HC REPAIR INCISIONAL HERNIA,INCAR/STRANG
|
Facility
|
OP
|
$9,417.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
4504956101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$4,708.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$694.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,103.91
|
| Rate for Payer: Aetna Government |
$1,103.91
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$4,708.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4,708.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
|
|
HC REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$1,454.00
|
|
|
Service Code
|
CPT 54163
|
| Hospital Charge Code |
3615416301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$253.21 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,502.91
|
| Rate for Payer: Aetna Government |
$2,502.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,752.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,752.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,752.04
|
| Rate for Payer: Brighton Health Commercial |
$1,090.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,502.91
|
| 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 |
$2,502.91
|
| Rate for Payer: EmblemHealth Commercial |
$2,502.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,252.62
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,127.47
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,227.59
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,502.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,227.59
|
| Rate for Payer: Group Health Inc Commercial |
$2,502.91
|
| Rate for Payer: Group Health Inc Medicare |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,502.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$959.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$253.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,127.47
|
| Rate for Payer: Healthfirst QHP |
$2,502.91
|
| Rate for Payer: Humana Medicare |
$2,552.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,502.91
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,502.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,502.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,377.76
|
| Rate for Payer: Wellcare Medicare |
$2,377.76
|
|
|
HC REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
IP
|
$1,454.00
|
|
|
Service Code
|
CPT 54163
|
| Hospital Charge Code |
3615416301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.00 |
| Max. Negotiated Rate |
$727.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$727.00
|
|
|
HC REPAIR LAC, FACE/MOUTH/TONGUE, <2.5CM
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
4504125001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| 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 REPAIR LAC, FACE/MOUTH/TONGUE, <2.5CM
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
4504125001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC REPAIR LAC, TONGUE, >2.6CM, COMPLEX
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
4504125201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$1,888.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$283.73
|
| Rate for Payer: Aetna Government |
$283.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$198.61
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$198.61
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$198.61
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$283.73
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$283.73
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$283.73
|
| 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 |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$255.36
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$241.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$252.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$283.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$252.52
|
| 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 |
$283.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$124.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$297.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$283.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$283.73
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$269.54
|
| Rate for Payer: Wellcare Medicare |
$269.54
|
|
|
HC REPAIR LAC, TONGUE, >2.6CM, COMPLEX
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
4504125201
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$308.00
|
|
|
HC REPAIR LIP,<1/2 VERT HEIGHT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
7614065201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$685.00 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$685.00
|
|
|
HC REPAIR LIP,<1/2 VERT HEIGHT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 40652
|
| Hospital Charge Code |
7614065201
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$1,027.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| 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 |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$428.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
|
HC REPAIR LIP,FULL THICK,VERMILION
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
7614065001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$622.21
|
| Rate for Payer: Aetna Government |
$622.21
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$435.55
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$435.55
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$435.55
|
| Rate for Payer: Brighton Health Commercial |
$1,002.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$559.99
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$528.88
|
| Rate for Payer: Fidelis Essential Plan QHP |
$553.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$622.21
|
| Rate for Payer: Fidelis Qualified Health Plan |
$553.77
|
| 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 |
$622.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$378.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$528.88
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$622.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$622.21
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$591.10
|
| Rate for Payer: Wellcare Medicare |
$591.10
|
|
