|
HC REPAIR LIP,FULL THICK,VERMILION
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
7614065001
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC REPAIR LIP,FULL THICK,VERMILION
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
4504065001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC REPAIR LIP,FULL THICK,VERMILION
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
4504065001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$2,134.00 |
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$622.21
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$622.21
|
| 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 |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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 MOUTH LAC < 2.5 CM
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
4504083001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$874.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 MOUTH LAC < 2.5 CM
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
4504083001
|
|
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 MOUTH LAC > 2.5CM
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
4504083101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$622.21
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$622.21
|
| 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 |
$792.81
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$673.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$622.21
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| 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 |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| 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 |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$622.21
|
| Rate for Payer: Humana Medicare |
$634.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$653.32
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$622.21
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| 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 MOUTH LAC > 2.5CM
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
4504083101
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$668.50 |
| Max. Negotiated Rate |
$668.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$668.50
|
|
|
HC REPAIR NAIL BED
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
3611176001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$732.00 |
| Max. Negotiated Rate |
$732.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$732.00
|
|
|
HC REPAIR NAIL BED
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
3611176001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$120.33 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$747.91
|
| Rate for Payer: Aetna Government |
$747.91
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$523.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$523.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$523.54
|
| Rate for Payer: Brighton Health Commercial |
$1,098.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$747.91
|
| 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 |
$747.91
|
| Rate for Payer: EmblemHealth Commercial |
$747.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$673.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$635.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$665.64
|
| Rate for Payer: Fidelis Medicare Advantage |
$747.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$665.64
|
| Rate for Payer: Group Health Inc Commercial |
$747.91
|
| Rate for Payer: Group Health Inc Medicare |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$747.91
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$120.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$125.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$635.72
|
| Rate for Payer: Healthfirst QHP |
$747.91
|
| Rate for Payer: Humana Medicare |
$762.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$747.91
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$747.91
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$747.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$710.51
|
| Rate for Payer: Wellcare Medicare |
$710.51
|
|
|
HC REPAIR PALATE LACER <2 CM
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
3614218001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$685.00 |
| Max. Negotiated Rate |
$685.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$685.00
|
|
|
HC REPAIR PALATE LACER <2 CM
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
3614218001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$218.85 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$622.21
|
| 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 |
$622.21
|
| Rate for Payer: Group Health Inc Medicare |
$622.21
|
| 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 |
$218.85
|
| 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 Commercial |
$1,113.00
|
| 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 SING TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
OP
|
$9,037.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
3613321801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.81 |
| 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 |
$452.81
|
| 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 REPAIR SING TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
IP
|
$9,037.00
|
|
|
Service Code
|
CPT 33218
|
| Hospital Charge Code |
3613321801
|
|
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 REPAIR SPICA/BODY/JACKET CAST
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
5102972001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.50 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$202.50
|
|
|
HC REPAIR SPICA/BODY/JACKET CAST
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
5102972001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.11 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$192.79
|
| Rate for Payer: Aetna Government |
$192.79
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$134.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$134.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$134.95
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$192.79
|
| 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 |
$192.79
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.51
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$163.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$171.58
|
| Rate for Payer: Fidelis Medicare Advantage |
$192.79
|
| Rate for Payer: Fidelis Qualified Health Plan |
$171.58
|
| 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 |
$192.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.11
|
| Rate for Payer: Healthfirst Medicare Advantage |
$163.87
|
| Rate for Payer: Healthfirst QHP |
$192.79
|
| Rate for Payer: Humana Medicare |
$196.65
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$202.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$192.79
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$192.79
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$183.15
|
|
|
HC REPAIR TONGUE LACER,POST 1/3
|
Facility
|
OP
|
$623.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
7614125101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.13 |
| Max. Negotiated Rate |
$3,092.52 |
| 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 |
$467.25
|
| 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 |
$3,092.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,628.64
|
| Rate for Payer: Elderplan Medicare Advantage |
$283.73
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$217.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$241.17
|
| Rate for Payer: Healthfirst QHP |
$283.73
|
| Rate for Payer: Humana Medicare |
$289.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$283.73
|
| 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 TONGUE LACER,POST 1/3
|
Facility
|
IP
|
$623.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
7614125101
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$311.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$311.50
|
|
|
HC REPAIR TWO TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
OP
|
$7,169.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
3613322001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$444.52 |
| Max. Negotiated Rate |
$5,376.75 |
| 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 |
$5,376.75
|
| 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 |
$444.52
|
| 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 REPAIR TWO TRANSVENOUS ELECTRODE, PERM PACEMKR OR IMPLBLE DEFRIB
|
Facility
|
IP
|
$7,169.00
|
|
|
Service Code
|
CPT 33220
|
| Hospital Charge Code |
3613322001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,584.50 |
| Max. Negotiated Rate |
$3,584.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,584.50
|
|
|
HC REPLACE CV CATH, CATHETER ONLY W SUBQ PUMP OR PORT
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 36578 TC
|
| Hospital Charge Code |
3613657801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC REPLACE CV CATH, CATHETER ONLY W SUBQ PUMP OR PORT
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 36578 TC
|
| Hospital Charge Code |
3613657801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$561.67 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$561.67
|
| Rate for Payer: Aetna Government |
$561.67
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| 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 |
$4,196.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,007.59
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
HC REPLACE CV CATH, COMPLETE, NON-TUNNELED, W/O SUBQ PORT OR PUMP
|
Facility
|
OP
|
$4,940.00
|
|
|
Service Code
|
CPT 36580 TC
|
| Hospital Charge Code |
3613658001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$231.24 |
| Max. Negotiated Rate |
$3,705.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.24
|
| Rate for Payer: Aetna Government |
$231.24
|
| Rate for Payer: Brighton Health Commercial |
$3,705.00
|
| 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 |
$2,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,470.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,729.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$632.40
|
| Rate for Payer: United Healthcare Commercial |
$1,188.00
|
|
|
HC REPLACE CV CATH, COMPLETE, NON-TUNNELED, W/O SUBQ PORT OR PUMP
|
Facility
|
IP
|
$4,940.00
|
|
|
Service Code
|
CPT 36580 TC
|
| Hospital Charge Code |
3613658001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.00 |
| Max. Negotiated Rate |
$2,470.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,470.00
|
|
|
HC REPLACE CV CATH, COMPLETE, TUNNELED, W/O SUBQ PORT OR PUMP
|
Facility
|
IP
|
$8,393.00
|
|
|
Service Code
|
CPT 36581 TC
|
| Hospital Charge Code |
3613658101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,196.50 |
| Max. Negotiated Rate |
$4,196.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
|
|
HC REPLACE CV CATH, COMPLETE, TUNNELED, W/O SUBQ PORT OR PUMP
|
Facility
|
OP
|
$8,393.00
|
|
|
Service Code
|
CPT 36581 TC
|
| Hospital Charge Code |
3613658101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$829.56 |
| Max. Negotiated Rate |
$6,294.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$829.56
|
| Rate for Payer: Aetna Government |
$829.56
|
| Rate for Payer: Brighton Health Commercial |
$6,294.75
|
| 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 |
$4,196.50
|
| Rate for Payer: Group Health Inc Commercial |
$4,196.50
|
| Rate for Payer: Group Health Inc Medicare |
$2,937.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,019.51
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
