|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY, W/ ARTHERECTOMY & STENT PLCMNT
|
Facility
|
OP
|
$48,278.00
|
|
|
Service Code
|
CPT 37227 TC
|
| Hospital Charge Code |
3613722701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$841.12 |
| Max. Negotiated Rate |
$36,208.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$841.12
|
| Rate for Payer: Aetna Government |
$841.12
|
| Rate for Payer: Brighton Health Commercial |
$36,208.50
|
| 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 |
$24,139.00
|
| Rate for Payer: Group Health Inc Commercial |
$24,139.00
|
| Rate for Payer: Group Health Inc Medicare |
$16,897.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,539.67
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY, W/ ARTHERECTOMY & STENT PLCMNT
|
Facility
|
IP
|
$48,278.00
|
|
|
Service Code
|
CPT 37227 TC
|
| Hospital Charge Code |
3613722701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,139.00 |
| Max. Negotiated Rate |
$24,139.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.00
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY, W/ STENT PLCMNT
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
3613722601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC REVASCN, ENDOVAS, FEMORAL, POPLITEAL ARTERY, W/ STENT PLCMNT
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
3613722601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$596.15 |
| Max. Negotiated Rate |
$22,507.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13,856.14
|
| Rate for Payer: Aetna Government |
$13,856.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,699.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,699.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9,699.30
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13,856.14
|
| 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 |
$13,856.14
|
| Rate for Payer: EmblemHealth Commercial |
$13,856.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,470.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11,777.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12,331.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,856.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12,331.96
|
| Rate for Payer: Group Health Inc Commercial |
$13,856.14
|
| Rate for Payer: Group Health Inc Medicare |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,578.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$596.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,777.72
|
| Rate for Payer: Healthfirst QHP |
$13,856.14
|
| Rate for Payer: Humana Medicare |
$14,133.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13,856.14
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,856.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,856.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,163.33
|
| Rate for Payer: Wellcare Medicare |
$13,163.33
|
|
|
HC REVASCN, ENDOVAS,ILIAC ARTERY
|
Facility
|
OP
|
$15,004.00
|
|
|
Service Code
|
CPT 37220 TC
|
| Hospital Charge Code |
3613722001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$11,253.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,431.80
|
| Rate for Payer: Aetna Government |
$3,431.80
|
| Rate for Payer: Brighton Health Commercial |
$11,253.00
|
| 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 |
$7,502.00
|
| Rate for Payer: Group Health Inc Commercial |
$7,502.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,251.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,425.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
HC REVASCN, ENDOVAS,ILIAC ARTERY
|
Facility
|
IP
|
$15,004.00
|
|
|
Service Code
|
CPT 37220 TC
|
| Hospital Charge Code |
3613722001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,502.00 |
| Max. Negotiated Rate |
$7,502.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,502.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART, INITIAL VESSEL
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
3613722801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,005.00 |
| Max. Negotiated Rate |
$15,005.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART, INITIAL VESSEL
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 37228
|
| Hospital Charge Code |
3613722801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$620.54 |
| Max. Negotiated Rate |
$22,507.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13,856.14
|
| Rate for Payer: Aetna Government |
$13,856.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9,699.30
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9,699.30
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9,699.30
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13,856.14
|
| 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 |
$13,856.14
|
| Rate for Payer: EmblemHealth Commercial |
$13,856.14
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12,470.53
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11,777.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12,331.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$13,856.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12,331.96
|
| Rate for Payer: Group Health Inc Commercial |
$13,856.14
|
| Rate for Payer: Group Health Inc Medicare |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13,856.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,603.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$620.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,777.72
|
| Rate for Payer: Healthfirst QHP |
$13,856.14
|
| Rate for Payer: Humana Medicare |
$14,133.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13,856.14
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,856.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13,856.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$13,163.33
|
| Rate for Payer: Wellcare Medicare |
$13,163.33
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/ARTHERECTOMY, ADD'L VESSEL
|
Facility
|
OP
|
$5,248.00
|
|
|
Service Code
|
CPT 37233 TC
|
| Hospital Charge Code |
3613723301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,592.77 |
| Max. Negotiated Rate |
$4,065.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,592.77
|
| Rate for Payer: Aetna Government |
$1,592.77
|
| Rate for Payer: Brighton Health Commercial |
$3,936.00
|
| 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 |
$2,624.00
|
| Rate for Payer: Group Health Inc Commercial |
$2,624.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,836.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,624.00
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/ARTHERECTOMY, ADD'L VESSEL
|
Facility
|
IP
|
$5,248.00
|
|
|
Service Code
|
CPT 37233 TC
|
| Hospital Charge Code |
3613723301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,624.00 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,624.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/ARTHERECTOMY, INITIAL VESSEL
|
Facility
|
IP
|
$48,278.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
3613722901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,139.00 |
| Max. Negotiated Rate |
$24,139.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/ARTHERECTOMY, INITIAL VESSEL
|
Facility
|
OP
|
$48,278.00
|
|
|
Service Code
|
CPT 37229
|
| Hospital Charge Code |
3613722901
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$786.67 |
| Max. Negotiated Rate |
$36,208.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,939.88
|
| Rate for Payer: Aetna Government |
$21,939.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15,357.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15,357.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,357.92
|
| Rate for Payer: Brighton Health Commercial |
$36,208.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,939.88
|
| 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 |
$21,939.88
|
| Rate for Payer: EmblemHealth Commercial |
$21,939.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,745.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18,648.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19,526.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,939.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,526.49
|
| Rate for Payer: Group Health Inc Commercial |
$21,939.88
|
| Rate for Payer: Group Health Inc Medicare |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,855.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$786.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,648.90
|
| Rate for Payer: Healthfirst QHP |
$21,939.88
|
| Rate for Payer: Humana Medicare |
$22,378.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,939.88
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,939.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,939.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,842.89
|
| Rate for Payer: Wellcare Medicare |
$20,842.89
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/ARTHTMY & STENT PLCMNT, INITIAL VESSEL
|
Facility
|
OP
|
$48,278.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
3613723101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$837.95 |
| Max. Negotiated Rate |
$36,208.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,939.88
|
| Rate for Payer: Aetna Government |
$21,939.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15,357.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15,357.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,357.92
|
| Rate for Payer: Brighton Health Commercial |
$36,208.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,939.88
|
| 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 |
$21,939.88
|
| Rate for Payer: EmblemHealth Commercial |
$21,939.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,745.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18,648.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19,526.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,939.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,526.49
|
| Rate for Payer: Group Health Inc Commercial |
$21,939.88
|
| Rate for Payer: Group Health Inc Medicare |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12,261.12
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$837.95
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,648.90
|
| Rate for Payer: Healthfirst QHP |
$21,939.88
|
| Rate for Payer: Humana Medicare |
$22,378.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,939.88
|
| Rate for Payer: United Healthcare Commercial |
$4,446.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,939.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,939.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,842.89
|
| Rate for Payer: Wellcare Medicare |
$20,842.89
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/ARTHTMY & STENT PLCMNT, INITIAL VESSEL
|
Facility
|
IP
|
$48,278.00
|
|
|
Service Code
|
CPT 37231
|
| Hospital Charge Code |
3613723101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,139.00 |
| Max. Negotiated Rate |
$24,139.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/STENT PLCMNT, INITIAL VESSEL
|
Facility
|
IP
|
$48,278.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
3613723001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24,139.00 |
| Max. Negotiated Rate |
$24,139.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,139.00
|
|
|
HC REVASCN, ENDOVAS, TIBIAL, PERONEAL ART W/STENT PLCMNT, INITIAL VESSEL
|
Facility
|
OP
|
$48,278.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
3613723001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$796.39 |
| Max. Negotiated Rate |
$36,208.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,939.88
|
| Rate for Payer: Aetna Government |
$21,939.88
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$15,357.92
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$15,357.92
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$15,357.92
|
| Rate for Payer: Brighton Health Commercial |
$36,208.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,939.88
|
| 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 |
$21,939.88
|
| Rate for Payer: EmblemHealth Commercial |
$21,939.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,745.89
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$18,648.90
|
| Rate for Payer: Fidelis Essential Plan QHP |
$19,526.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,939.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$19,526.49
|
| Rate for Payer: Group Health Inc Commercial |
$21,939.88
|
| Rate for Payer: Group Health Inc Medicare |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,939.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,438.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$796.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,648.90
|
| Rate for Payer: Healthfirst QHP |
$21,939.88
|
| Rate for Payer: Humana Medicare |
$22,378.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,939.88
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,939.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,939.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,842.89
|
| Rate for Payer: Wellcare Medicare |
$20,842.89
|
|
|
HC REVIEW MEDICAL DATA
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
9839908001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$56.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$60.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51.00
|
| Rate for Payer: EmblemHealth Commercial |
$37.50
|
| Rate for Payer: Group Health Inc Commercial |
$37.50
|
| Rate for Payer: Group Health Inc Medicare |
$26.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
|
|
HC REVIEW MEDICAL DATA
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 99080
|
| Hospital Charge Code |
9839908001
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$37.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
|
|
HC REVISE EYELASHES BY OTH THN FORCEPS
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
5106782501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.57 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$365.24
|
| Rate for Payer: Aetna Government |
$365.24
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$255.67
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$255.67
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$255.67
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$365.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$365.24
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$328.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$310.45
|
| Rate for Payer: Fidelis Essential Plan QHP |
$325.06
|
| Rate for Payer: Fidelis Medicare Advantage |
$365.24
|
| Rate for Payer: Fidelis Qualified Health Plan |
$325.06
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$365.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$79.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$138.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$310.45
|
| Rate for Payer: Healthfirst QHP |
$365.24
|
| Rate for Payer: Humana Medicare |
$372.54
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$383.50
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$365.24
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$365.24
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$346.98
|
| Rate for Payer: Wellcare Medicare |
$346.98
|
|
|
HC REVISE EYELASHES BY OTH THN FORCEPS
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 67825
|
| Hospital Charge Code |
5106782501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$397.00 |
| Max. Negotiated Rate |
$397.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$397.00
|
|
|
HC REVISION OF COLOSTOMY, SIMPLE
|
Facility
|
IP
|
$9,017.00
|
|
|
Service Code
|
CPT 44340
|
| Hospital Charge Code |
4504434001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,508.50 |
| Max. Negotiated Rate |
$4,508.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,508.50
|
|
|
HC REVISION OF COLOSTOMY, SIMPLE
|
Facility
|
OP
|
$9,017.00
|
|
|
Service Code
|
CPT 44340
|
| Hospital Charge Code |
4504434001
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$4,696.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,473.05
|
| Rate for Payer: Aetna Government |
$4,473.05
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,131.14
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,131.14
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,131.14
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$4,473.05
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$4,473.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$4,473.05
|
| 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 |
$4,473.05
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4,025.74
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,802.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,981.01
|
| Rate for Payer: Fidelis Medicare Advantage |
$4,473.05
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,981.01
|
| 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 |
$4,473.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,957.33
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$4,473.05
|
| Rate for Payer: Humana Medicare |
$4,562.51
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$4,696.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$4,473.05
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,473.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4,473.05
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4,249.40
|
| Rate for Payer: Wellcare Medicare |
$4,249.40
|
|
|
HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
3028643101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
|
HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
3028643101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.67
|
| Rate for Payer: Aetna Government |
$5.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$3.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3.97
|
| Rate for Payer: Brighton Health Commercial |
$11.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.65
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.67
|
| Rate for Payer: EmblemHealth Commercial |
$5.67
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5.10
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.05
|
| Rate for Payer: Group Health Inc Commercial |
$5.67
|
| Rate for Payer: Group Health Inc Medicare |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Healthfirst Essential Plan |
$11.81
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.67
|
| Rate for Payer: Healthfirst QHP |
$5.67
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.67
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5.25
|
| Rate for Payer: Wellcare Medicare |
$5.10
|
|
|
HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
3028643001
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.50
|
|
