|
LAMOTRIGINE 25 MG PO TABS [13981]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 00904700761
|
| Hospital Charge Code |
00904700761
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
LAMOTRIGINE 25 MG PO TABS [13981]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 68084031801
|
| Hospital Charge Code |
68084031801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
LAMOTRIGINE 25 MG PO TABS [13981]
|
Facility
|
OP
|
$4.16
|
|
|
Service Code
|
NDC 65862022701
|
| Hospital Charge Code |
65862022701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.08
|
| Rate for Payer: Aetna Government |
$2.08
|
| Rate for Payer: Brighton Health Commercial |
$3.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.83
|
| Rate for Payer: Group Health Inc Commercial |
$2.08
|
| Rate for Payer: Group Health Inc Medicare |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
|
|
LAMOTRIGINE 25 MG TAB
|
Facility
|
OP
|
$0.18
|
|
| Hospital Charge Code |
41652706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
LAMOTRIGINE 25 MG TAB
|
Facility
|
OP
|
$0.18
|
|
| Hospital Charge Code |
41642706
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
LAMOTRIGINE (LAMICTAL), SERUM
|
Facility
|
IP
|
$33.13
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
40609003
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$13.25
|
|
|
LAMOTRIGINE (LAMICTAL), SERUM
|
Facility
|
OP
|
$33.13
|
|
|
Service Code
|
HCPCS 80175
|
| Hospital Charge Code |
40609003
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.28 |
| Max. Negotiated Rate |
$26.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.25
|
| Rate for Payer: Aetna Government |
$13.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.28
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.28
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.28
|
| Rate for Payer: Brighton Health Commercial |
$24.85
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Cash Price |
$13.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$13.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$13.25
|
| Rate for Payer: EmblemHealth Commercial |
$13.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.79
|
| Rate for Payer: Fidelis Medicare Advantage |
$13.25
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.79
|
| Rate for Payer: Group Health Inc Commercial |
$13.25
|
| Rate for Payer: Group Health Inc Medicare |
$13.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.25
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13.25
|
| Rate for Payer: Healthfirst QHP |
$13.25
|
| Rate for Payer: Humana Medicare |
$13.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$16.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$13.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.60
|
| Rate for Payer: Wellcare Medicare |
$11.92
|
|
|
LAMP GOOSE NECK W/WHEELS
|
Facility
|
OP
|
$210.95
|
|
| Hospital Charge Code |
64902989
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$73.83 |
| Max. Negotiated Rate |
$168.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$116.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$105.48
|
| Rate for Payer: Aetna Government |
$105.48
|
| Rate for Payer: Brighton Health Commercial |
$158.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$168.76
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$143.45
|
| Rate for Payer: Group Health Inc Commercial |
$105.48
|
| Rate for Payer: Group Health Inc Medicare |
$73.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.48
|
|
|
LAMP LARYING CLR PRE-FOUCS SM
|
Facility
|
OP
|
$21.04
|
|
| Hospital Charge Code |
40200480
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.52
|
| Rate for Payer: Aetna Government |
$10.52
|
| Rate for Payer: Brighton Health Commercial |
$15.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.31
|
| Rate for Payer: Group Health Inc Commercial |
$10.52
|
| Rate for Payer: Group Health Inc Medicare |
$7.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.52
|
|
|
LAMP LARYNG CLEAR PRE-FOCUS LGE
|
Facility
|
OP
|
$21.04
|
|
| Hospital Charge Code |
40200479
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.52
|
| Rate for Payer: Aetna Government |
$10.52
|
| Rate for Payer: Brighton Health Commercial |
$15.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.31
|
| Rate for Payer: Group Health Inc Commercial |
$10.52
|
| Rate for Payer: Group Health Inc Medicare |
$7.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.52
|
|
|
LAMP LARYNG FROST PRE-FOCUS LGE
|
Facility
|
OP
|
$21.04
|
|
| Hospital Charge Code |
40200481
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$16.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.57
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.52
|
| Rate for Payer: Aetna Government |
$10.52
|
| Rate for Payer: Brighton Health Commercial |
$15.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.31
|
| Rate for Payer: Group Health Inc Commercial |
$10.52
|
| Rate for Payer: Group Health Inc Medicare |
$7.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.52
|
|
|
LAMP QUARTZLINE 120V 150W
|
Facility
|
OP
|
$53.85
|
|
| Hospital Charge Code |
64903295
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26.92
|
| Rate for Payer: Aetna Government |
$26.92
|
| Rate for Payer: Brighton Health Commercial |
$40.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$36.62
|
| Rate for Payer: Group Health Inc Commercial |
$26.92
|
| Rate for Payer: Group Health Inc Medicare |
$18.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26.92
|
|
|
LAMP XENON
|
Facility
|
OP
|
$51.08
|
|
| Hospital Charge Code |
64902894
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$40.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.54
|
| Rate for Payer: Aetna Government |
$25.54
|
| Rate for Payer: Brighton Health Commercial |
$38.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$40.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.73
|
| Rate for Payer: Group Health Inc Commercial |
$25.54
|
| Rate for Payer: Group Health Inc Medicare |
$17.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.54
|
|
|
LANCET,HEEL,1.0MM DEPTH,TEAL,QUK
|
Facility
|
OP
|
$2.63
|
|
| Hospital Charge Code |
64903263
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.32
|
| Rate for Payer: Aetna Government |
$1.32
|
| Rate for Payer: Brighton Health Commercial |
$1.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.79
|
| Rate for Payer: Group Health Inc Commercial |
$1.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.32
|
|
|
LANCET,SAFETY,23G,1.8MM,AC L
|
Facility
|
OP
|
$43.13
|
|
| Hospital Charge Code |
64906204
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.56
|
| Rate for Payer: Aetna Government |
$21.56
|
| Rate for Payer: Brighton Health Commercial |
$32.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.33
|
| Rate for Payer: Group Health Inc Commercial |
$21.56
|
| Rate for Payer: Group Health Inc Medicare |
$15.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.56
|
|
|
LANCET SAF-T-PRO
|
Facility
|
OP
|
$0.39
|
|
| Hospital Charge Code |
64902512
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
|
|
LANGSTON DUAL LUMEN CATH 6FR
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66521955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.00
|
|
|
LANGSTON DUAL LUMEN CATH 6FR
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
66521955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$44.85 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$44.85
|
| Rate for Payer: Aetna Government |
$44.85
|
| Rate for Payer: Brighton Health Commercial |
$154.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.35
|
| Rate for Payer: EmblemHealth Commercial |
$129.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.90
|
| Rate for Payer: Group Health Inc Commercial |
$129.00
|
| Rate for Payer: Group Health Inc Medicare |
$90.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.70
|
|
|
LANREOTIDE ACETATE 120 MG/0.5ML SC SOLN [87861]
|
Facility
|
OP
|
$22,948.80
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
15054112004
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$18,359.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,621.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$48.44
|
| Rate for Payer: Aetna Government |
$48.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$33.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$33.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$33.91
|
| Rate for Payer: Brighton Health Commercial |
$17,211.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$48.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,359.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,605.18
|
| Rate for Payer: Elderplan Medicare Advantage |
$48.44
|
| Rate for Payer: EmblemHealth Commercial |
$48.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$41.18
|
| Rate for Payer: Fidelis Essential Plan QHP |
$43.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$48.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$43.11
|
| Rate for Payer: Group Health Inc Commercial |
$48.44
|
| Rate for Payer: Group Health Inc Medicare |
$48.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,474.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$48.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$41.18
|
| Rate for Payer: Healthfirst QHP |
$48.44
|
| Rate for Payer: Humana Medicare |
$49.41
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$48.00
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$50.88
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$50.88
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$50.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$48.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,916.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$38.75
|
| Rate for Payer: Wellcare Medicare |
$46.02
|
|
|
LAP APPENDECTOMY
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
40010585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4,065.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
LAP APPENDECTOMY
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 44970
|
| Hospital Charge Code |
40010585
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
|
LAPARO ABLATION OF RENAL MASS
|
Facility
|
IP
|
$25,481.20
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
40014106
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$11,903.87
|
|
|
LAPARO ABLATION OF RENAL MASS
|
Facility
|
OP
|
$25,481.20
|
|
|
Service Code
|
HCPCS 50542
|
| Hospital Charge Code |
40014106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$19,110.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5,593.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11,903.87
|
| Rate for Payer: Aetna Government |
$11,903.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$8,332.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$8,332.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$8,332.71
|
| Rate for Payer: Brighton Health Commercial |
$19,110.90
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Cash Price |
$11,903.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11,903.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$11,903.87
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10,118.29
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10,594.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$11,903.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10,594.44
|
| Rate for Payer: Group Health Inc Commercial |
$11,903.87
|
| Rate for Payer: Group Health Inc Medicare |
$11,903.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12,740.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,903.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,118.29
|
| Rate for Payer: Healthfirst QHP |
$11,903.87
|
| Rate for Payer: Humana Medicare |
$12,141.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11,903.87
|
| Rate for Payer: United Healthcare Commercial |
$3,190.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,903.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11,903.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9,523.10
|
| Rate for Payer: Wellcare Medicare |
$11,308.68
|
|
|
LAPARO HERNIA REPAIR INITIAL
|
Facility
|
OP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
40019434
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$10,980.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6,672.53
|
| Rate for Payer: Aetna Government |
$6,672.53
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4,670.77
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4,670.77
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4,670.77
|
| Rate for Payer: Brighton Health Commercial |
$10,980.08
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Cash Price |
$6,672.53
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6,672.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$6,672.53
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5,671.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5,938.55
|
| Rate for Payer: Fidelis Medicare Advantage |
$6,672.53
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5,938.55
|
| Rate for Payer: Group Health Inc Commercial |
$6,672.53
|
| Rate for Payer: Group Health Inc Medicare |
$6,672.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7,320.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6,672.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5,671.65
|
| Rate for Payer: Healthfirst QHP |
$6,672.53
|
| Rate for Payer: Humana Medicare |
$6,805.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6,672.53
|
| Rate for Payer: United Healthcare Commercial |
$2,546.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,672.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6,672.53
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$5,338.02
|
| Rate for Payer: Wellcare Medicare |
$6,338.90
|
|
|
LAPARO HERNIA REPAIR INITIAL
|
Facility
|
IP
|
$14,640.10
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
40019434
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$6,672.53
|
|
