|
HC SURGICAL PREP OF SITE BY EXCISION, 1ST 100 SQCM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
3611500201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC SURGICAL PREP OF SITE BY EXCISION, 1ST 100 SQCM
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
3611500401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC SURGICAL PREP OF SITE BY EXCISION, 1ST 100 SQCM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
3611500401
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$297.64 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| 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 |
$1,128.75
|
| 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 |
$328.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$297.64
|
| 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 SURGICAL PREP OF SITE BY EXCISION, 1ST 100 SQCM
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
3611500201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$255.19 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,234.99
|
| Rate for Payer: Aetna Government |
$2,234.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,564.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,564.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,564.49
|
| Rate for Payer: Brighton Health Commercial |
$1,128.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,234.99
|
| 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 |
$2,234.99
|
| Rate for Payer: EmblemHealth Commercial |
$2,234.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2,011.49
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,899.74
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,989.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,234.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,989.14
|
| Rate for Payer: Group Health Inc Commercial |
$2,234.99
|
| Rate for Payer: Group Health Inc Medicare |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,234.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$981.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$255.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,899.74
|
| Rate for Payer: Healthfirst QHP |
$2,234.99
|
| Rate for Payer: Humana Medicare |
$2,279.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,234.99
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,234.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,234.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,123.24
|
| Rate for Payer: Wellcare Medicare |
$2,123.24
|
|
|
HC SURGICAL PREP OF SITE BY EXCISION, EACH ADD'L 100 SQCM (ADDON)
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
3611500301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$474.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.50
|
|
|
HC SURGICAL PREP OF SITE BY EXCISION, EACH ADD'L 100 SQCM (ADDON)
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
3611500301
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.21 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40.21
|
| Rate for Payer: Aetna Government |
$40.21
|
| Rate for Payer: Brighton Health Commercial |
$711.75
|
| 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 |
$474.50
|
| Rate for Payer: Group Health Inc Commercial |
$474.50
|
| Rate for Payer: Group Health Inc Medicare |
$332.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$474.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$52.04
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC SURGICAL PREP OF SITE BY EXCISION, EACH ADD'L 100 SQCM (ADDON)
|
Facility
|
OP
|
$949.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
3611500501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.96 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$79.96
|
| Rate for Payer: Aetna Government |
$79.96
|
| Rate for Payer: Brighton Health Commercial |
$711.75
|
| 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 |
$474.50
|
| Rate for Payer: Group Health Inc Commercial |
$474.50
|
| Rate for Payer: Group Health Inc Medicare |
$332.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$474.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$104.86
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
|
|
HC SURGICAL PREP OF SITE BY EXCISION, EACH ADD'L 100 SQCM (ADDON)
|
Facility
|
IP
|
$949.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
3611500501
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.50 |
| Max. Negotiated Rate |
$474.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$474.50
|
|
|
HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
3128830001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$37.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29.92
|
| Rate for Payer: Aetna Government |
$29.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$20.94
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$20.94
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20.94
|
| Rate for Payer: Brighton Health Commercial |
$29.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$29.92
|
| Rate for Payer: EmblemHealth Commercial |
$19.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26.93
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$25.43
|
| Rate for Payer: Fidelis Essential Plan QHP |
$26.63
|
| Rate for Payer: Fidelis Medicare Advantage |
$29.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26.63
|
| Rate for Payer: Group Health Inc Commercial |
$29.92
|
| Rate for Payer: Group Health Inc Medicare |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$29.92
|
| Rate for Payer: Healthfirst QHP |
$29.92
|
| Rate for Payer: Humana Medicare |
$30.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28.42
|
| Rate for Payer: Wellcare Medicare |
$26.93
|
|
|
HC SURG PATH,GROSS,LEVEL I - LAB SURG PATH,GROSS,LEVEL I
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
3128830001
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 88304 TC
|
| Hospital Charge Code |
3128830401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
|
|
HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 88304 TC
|
| Hospital Charge Code |
3128830401
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22.00
|
| Rate for Payer: Aetna Government |
$22.00
|
| Rate for Payer: Brighton Health Commercial |
$111.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52.50
|
| Rate for Payer: EmblemHealth Commercial |
$37.10
|
| Rate for Payer: Group Health Inc Commercial |
$74.50
|
| Rate for Payer: Group Health Inc Medicare |
$52.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$25.58
|
| Rate for Payer: Healthfirst Essential Plan |
$57.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$25.58
|
|
|
HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 88302 TC
|
| Hospital Charge Code |
3128830201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
|
|
HC SURG PATH,LEVEL II - LAB SURG PATH,LEVEL II
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 88302 TC
|
| Hospital Charge Code |
3128830201
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$56.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$37.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.30
|
| Rate for Payer: Aetna Government |
$16.30
|
| Rate for Payer: Brighton Health Commercial |
$51.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$47.68
|
| Rate for Payer: EmblemHealth Commercial |
$31.28
|
| Rate for Payer: Group Health Inc Commercial |
$34.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19.50
|
| Rate for Payer: Healthfirst Essential Plan |
$43.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.50
|
|
|
HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
3128830501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$74.50 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.50
|
|
|
HC SURG PATH,LEVEL IV - LAB SURG PATH,LEVEL IV
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
3128830501
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$98.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$81.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$65.28
|
| Rate for Payer: Aetna Government |
$65.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$45.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$45.70
|
| Rate for Payer: Brighton Health Commercial |
$65.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$65.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$84.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$70.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$65.28
|
| Rate for Payer: EmblemHealth Commercial |
$80.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$58.75
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$55.49
|
| Rate for Payer: Fidelis Essential Plan QHP |
$58.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$65.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$58.10
|
| Rate for Payer: Group Health Inc Commercial |
$65.28
|
| Rate for Payer: Group Health Inc Medicare |
$65.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$65.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$65.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$43.62
|
| Rate for Payer: Healthfirst Essential Plan |
$98.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$65.28
|
| Rate for Payer: Healthfirst QHP |
$65.28
|
| Rate for Payer: Humana Medicare |
$66.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$65.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$65.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.62
|
| Rate for Payer: Wellcare Medicare |
$58.75
|
|
|
HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI
|
Facility
|
OP
|
$1,902.00
|
|
|
Service Code
|
CPT 88309 TC
|
| Hospital Charge Code |
3128830901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$203.65 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,046.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$203.65
|
| Rate for Payer: Aetna Government |
$203.65
|
| Rate for Payer: Brighton Health Commercial |
$1,426.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$246.21
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$207.24
|
| Rate for Payer: EmblemHealth Commercial |
$337.06
|
| Rate for Payer: Group Health Inc Commercial |
$951.00
|
| Rate for Payer: Group Health Inc Medicare |
$665.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$951.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$267.64
|
| Rate for Payer: Healthfirst Essential Plan |
$602.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$267.64
|
|
|
HC SURG PATH,LEVEL VI - LAB SURG PATH,LEVEL VI
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT 88309 TC
|
| Hospital Charge Code |
3128830901
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$951.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$951.00
|
|
|
HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V
|
Facility
|
OP
|
$858.00
|
|
|
Service Code
|
CPT 88307 TC
|
| Hospital Charge Code |
3128830701
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$143.36 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$471.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$143.36
|
| Rate for Payer: Aetna Government |
$143.36
|
| Rate for Payer: Brighton Health Commercial |
$643.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$177.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.22
|
| Rate for Payer: EmblemHealth Commercial |
$242.74
|
| Rate for Payer: Group Health Inc Commercial |
$429.00
|
| Rate for Payer: Group Health Inc Medicare |
$300.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$429.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$176.15
|
| Rate for Payer: Healthfirst Essential Plan |
$396.34
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$176.15
|
|
|
HC SURG PATH,LEVEL V - LAB SURG PATH,LEVEL V
|
Facility
|
IP
|
$858.00
|
|
|
Service Code
|
CPT 88307 TC
|
| Hospital Charge Code |
3128830701
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$429.00 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.00
|
|
|
HC SURG REM ERUP TOOTH REQ FLAP/BONE
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT D7210
|
| Hospital Charge Code |
361D721001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$106.00
|
|
|
HC SURG REM ERUP TOOTH REQ FLAP/BONE
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT D7210
|
| Hospital Charge Code |
361D721001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.60 |
| Max. Negotiated Rate |
$1,846.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,809.86
|
| Rate for Payer: Aetna Government |
$1,809.86
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,266.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,266.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,266.90
|
| Rate for Payer: Brighton Health Commercial |
$159.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,809.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$169.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$144.16
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,809.86
|
| Rate for Payer: EmblemHealth Commercial |
$1,809.86
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,628.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,538.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,610.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,809.86
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,610.78
|
| Rate for Payer: Group Health Inc Commercial |
$1,809.86
|
| Rate for Payer: Group Health Inc Medicare |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,809.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$657.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,538.38
|
| Rate for Payer: Healthfirst QHP |
$1,809.86
|
| Rate for Payer: Humana Medicare |
$1,846.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,809.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,809.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,809.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,719.37
|
| Rate for Payer: Wellcare Medicare |
$1,719.37
|
|
|
HC SURG REM OF RESIDUAL TOOTH ROOTS
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT D7250
|
| Hospital Charge Code |
361D725001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.50 |
| Max. Negotiated Rate |
$72.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72.50
|
|
|
HC SURG REM OF RESIDUAL TOOTH ROOTS
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT D7250
|
| Hospital Charge Code |
361D725001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.75 |
| Max. Negotiated Rate |
$2,072.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$79.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,031.43
|
| Rate for Payer: Aetna Government |
$2,031.43
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,422.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,422.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,422.00
|
| Rate for Payer: Brighton Health Commercial |
$108.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,031.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$98.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$2,031.43
|
| Rate for Payer: EmblemHealth Commercial |
$2,031.43
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,828.29
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,726.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,807.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,031.43
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,807.97
|
| Rate for Payer: Group Health Inc Commercial |
$2,031.43
|
| Rate for Payer: Group Health Inc Medicare |
$2,031.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,031.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$892.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,726.72
|
| Rate for Payer: Healthfirst QHP |
$2,031.43
|
| Rate for Payer: Humana Medicare |
$2,072.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,031.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,031.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,031.43
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,929.86
|
| Rate for Payer: Wellcare Medicare |
$1,929.86
|
|
|
HC SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MYCOBACTERIA, PROPORTION METHOD, EACH AGENT
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87190
|
| Hospital Charge Code |
3068719001
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$16.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.31
|
| Rate for Payer: Aetna Government |
$7.31
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.12
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.12
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.12
|
| Rate for Payer: Brighton Health Commercial |
$16.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$7.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$7.31
|
| Rate for Payer: EmblemHealth Commercial |
$7.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.21
|
| Rate for Payer: Fidelis Essential Plan QHP |
$6.51
|
| Rate for Payer: Fidelis Medicare Advantage |
$7.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$7.31
|
| Rate for Payer: Group Health Inc Medicare |
$7.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$7.31
|
| Rate for Payer: Healthfirst Essential Plan |
$16.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7.31
|
| Rate for Payer: Healthfirst QHP |
$7.31
|
| Rate for Payer: Humana Medicare |
$7.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$7.31
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$7.31
|
| Rate for Payer: Wellcare Medicare |
$6.58
|
|
