|
HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, ADD'L VEIN (EXCL LOWER EXT)
|
Facility
|
OP
|
$15,474.00
|
|
|
Service Code
|
CPT 37237 TC
|
| Hospital Charge Code |
3613723701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$11,605.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,670.81
|
| Rate for Payer: Aetna Government |
$2,670.81
|
| Rate for Payer: Brighton Health Commercial |
$11,605.50
|
| 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 |
$7,737.00
|
| Rate for Payer: Group Health Inc Commercial |
$7,737.00
|
| Rate for Payer: Group Health Inc Medicare |
$5,415.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,737.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,737.00
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
|
|
HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, ADD'L VEIN (EXCL LOWER EXT)
|
Facility
|
IP
|
$15,474.00
|
|
|
Service Code
|
CPT 37237 TC
|
| Hospital Charge Code |
3613723701
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,737.00 |
| Max. Negotiated Rate |
$7,737.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,737.00
|
|
|
HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, INITIAL VEIN
|
Facility
|
OP
|
$30,010.00
|
|
|
Service Code
|
CPT 37238 TC
|
| Hospital Charge Code |
3613723801
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,628.64 |
| Max. Negotiated Rate |
$22,507.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,550.14
|
| Rate for Payer: Aetna Government |
$4,550.14
|
| Rate for Payer: Brighton Health Commercial |
$22,507.50
|
| 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 |
$15,005.00
|
| Rate for Payer: Group Health Inc Commercial |
$15,005.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,503.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,005.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,102.24
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, INITIAL VEIN
|
Facility
|
IP
|
$30,010.00
|
|
|
Service Code
|
CPT 37238 TC
|
| Hospital Charge Code |
3613723801
|
|
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 TRANSVASC PLACEMENT INTRAVASCULAR STENT, INITIAL VEIN (EXCL LOWER EXT)
|
Facility
|
IP
|
$30,948.00
|
|
|
Service Code
|
CPT 37236 TC
|
| Hospital Charge Code |
3613723601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15,474.00 |
| Max. Negotiated Rate |
$15,474.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
|
|
HC TRANSVASC PLACEMENT INTRAVASCULAR STENT, INITIAL VEIN (EXCL LOWER EXT)
|
Facility
|
OP
|
$30,948.00
|
|
|
Service Code
|
CPT 37236 TC
|
| Hospital Charge Code |
3613723601
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,628.64 |
| Max. Negotiated Rate |
$23,211.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4,462.68
|
| Rate for Payer: Aetna Government |
$4,462.68
|
| Rate for Payer: Brighton Health Commercial |
$23,211.00
|
| 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 |
$15,474.00
|
| Rate for Payer: Group Health Inc Commercial |
$15,474.00
|
| Rate for Payer: Group Health Inc Medicare |
$10,831.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15,474.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7,024.47
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
|
|
HC TRANSVESICAL URETEROLITHOTOMY
|
Facility
|
OP
|
$5,365.00
|
|
|
Service Code
|
CPT 51060
|
| Hospital Charge Code |
3615106001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$667.92 |
| Max. Negotiated Rate |
$4,023.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| 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 |
$4,023.75
|
| 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 |
$2,502.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$667.92
|
| 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 |
$2,683.00
|
| 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 TRANSVESICAL URETEROLITHOTOMY
|
Facility
|
IP
|
$5,365.00
|
|
|
Service Code
|
CPT 51060
|
| Hospital Charge Code |
3615106001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,682.50 |
| Max. Negotiated Rate |
$2,682.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.50
|
|
|
HC TRAUMA RESP W/CRITICAL CARE
|
Facility
|
OP
|
$2,744.00
|
|
|
Service Code
|
CPT G0390
|
| Hospital Charge Code |
681G039001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,131.68 |
| Max. Negotiated Rate |
$2,195.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,509.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,616.68
|
| Rate for Payer: Aetna Government |
$1,616.68
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,131.68
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,131.68
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,131.68
|
| Rate for Payer: Brighton Health Commercial |
$2,058.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,616.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,195.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,865.92
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,616.68
|
| Rate for Payer: EmblemHealth Commercial |
$1,616.68
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$1,455.01
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,374.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,438.85
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,616.68
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,438.85
|
| Rate for Payer: Group Health Inc Commercial |
$1,616.68
|
| Rate for Payer: Group Health Inc Medicare |
$1,616.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,616.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,616.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,374.18
|
| Rate for Payer: Healthfirst QHP |
$1,616.68
|
| Rate for Payer: Humana Medicare |
$1,649.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,616.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,616.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,616.68
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,535.85
|
| Rate for Payer: Wellcare Medicare |
$1,535.85
|
|
|
HC TRAUMA RESP W/CRITICAL CARE
|
Facility
|
IP
|
$2,744.00
|
|
|
Service Code
|
CPT G0390
|
| Hospital Charge Code |
681G039001
|
|
Hospital Revenue Code
|
681
|
| Min. Negotiated Rate |
$1,372.00 |
| Max. Negotiated Rate |
$1,372.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,372.00
|
|
|
HC TRB@ GENE REARRANGE ANALYSIS -AMPLIFICATION
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
3108134001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.24 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$208.92
|
| Rate for Payer: Aetna Government |
$208.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$146.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$146.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$146.24
|
| Rate for Payer: Brighton Health Commercial |
$208.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$208.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$417.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$354.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$208.92
|
| Rate for Payer: EmblemHealth Commercial |
$208.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$188.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$177.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$185.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$208.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$185.94
|
| Rate for Payer: Group Health Inc Commercial |
$208.92
|
| Rate for Payer: Group Health Inc Medicare |
$208.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$208.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$208.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$208.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$208.92
|
| Rate for Payer: Healthfirst QHP |
$208.92
|
| Rate for Payer: Humana Medicare |
$213.10
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$208.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$208.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$208.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.47
|
| Rate for Payer: Wellcare Medicare |
$188.03
|
|
|
HC TRB@ GENE REARRANGE ANALYSIS -AMPLIFICATION
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
3108134001
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$261.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.00
|
|
|
HC TREAT EYELID BY INJECTION
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
5106820001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$511.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$487.56
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| 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 |
$38.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$414.43
|
| 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 |
$222.00
|
| 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 TREAT EYELID BY INJECTION
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 68200
|
| Hospital Charge Code |
5106820001
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$165.00
|
|
|
HC TREATMENT FOR RETINAL LESION
|
Facility
|
IP
|
$1,535.00
|
|
|
Service Code
|
CPT 67228
|
| Hospital Charge Code |
5106722801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$767.50 |
| Max. Negotiated Rate |
$767.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$767.50
|
|
|
HC TREATMENT FOR RETINAL LESION
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
CPT 67228
|
| Hospital Charge Code |
5106722801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.41 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$233.00
|
| 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 |
$217.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$184.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$670.29
|
| Rate for Payer: EmblemHealth Commercial |
$250.00
|
| 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 |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$670.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$172.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$338.22
|
| 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: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$703.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$670.29
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| 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 TREATMENT OF INCOMPLETE ABORT - ANY TRIMESTER
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
3615981201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC TREATMENT OF INCOMPLETE ABORT - ANY TRIMESTER
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
3615981201
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$373.58 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$373.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC TREATMENT OF MISSED ABORT - 1ST TRIMESTER
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
3615982001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$467.98 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$467.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC TREATMENT OF MISSED ABORT - 1ST TRIMESTER
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
3615982001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC TREATMENT OF MISSED ABORT - 2ND TRIMESTER
|
Facility
|
OP
|
$7,566.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
3615982101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$458.25 |
| Max. Negotiated Rate |
$5,674.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,880.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,884.81
|
| Rate for Payer: Aetna Government |
$3,884.81
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,719.37
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,719.37
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,719.37
|
| Rate for Payer: Brighton Health Commercial |
$5,674.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,884.81
|
| 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 |
$3,884.81
|
| Rate for Payer: EmblemHealth Commercial |
$3,884.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,496.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,302.09
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,457.48
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,884.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,457.48
|
| Rate for Payer: Group Health Inc Commercial |
$3,884.81
|
| Rate for Payer: Group Health Inc Medicare |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,884.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,674.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$458.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,302.09
|
| Rate for Payer: Healthfirst QHP |
$3,884.81
|
| Rate for Payer: Humana Medicare |
$3,962.51
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,884.81
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,884.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,884.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$3,690.57
|
| Rate for Payer: Wellcare Medicare |
$3,690.57
|
|
|
HC TREATMENT OF MISSED ABORT - 2ND TRIMESTER
|
Facility
|
IP
|
$7,566.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
3615982101
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,783.00 |
| Max. Negotiated Rate |
$3,783.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,783.00
|
|
|
HC TREATMT SUPERFICIAL WOUND DEHISCENCE
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
3611202001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$752.50 |
| Max. Negotiated Rate |
$752.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.50
|
|
|
HC TREATMT SUPERFICIAL WOUND DEHISCENCE
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
3611202001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$220.26 |
| Max. Negotiated Rate |
$3,092.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| 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 |
$220.26
|
| 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 TREAT THUMB FX/DISLOC,MANIP
|
Facility
|
IP
|
$4,302.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
7612664501
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$2,151.00 |
| Max. Negotiated Rate |
$2,151.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,151.00
|
|
