|
LAYER CLOSURE OF WOUND 5.1- 7.5CM
|
Facility
|
OP
|
$967.73
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
30305074
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$461.12
|
| Rate for Payer: Aetna Government |
$461.12
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$322.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$322.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$322.78
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Cash Price |
$461.12
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$461.12
|
| 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 |
$461.12
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$391.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$410.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$461.12
|
| Rate for Payer: Fidelis Qualified Health Plan |
$410.40
|
| 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 |
$483.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$461.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$391.95
|
| Rate for Payer: Healthfirst QHP |
$461.12
|
| Rate for Payer: Humana Medicare |
$470.34
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$461.12
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$461.12
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$461.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$461.12
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$368.90
|
| Rate for Payer: Wellcare Medicare |
$438.06
|
|
|
LAYER CLOSURE OF WOUND 5.1- 7.5CM
|
Facility
|
IP
|
$967.73
|
|
|
Service Code
|
HCPCS 12053
|
| Hospital Charge Code |
30305074
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$461.12
|
|
|
LAYER CLOSURE OF WOUNDS
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
40019864
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.40 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$508.40
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$508.40
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$508.40
|
| Rate for Payer: Brighton Health Commercial |
$1,129.01
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| 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 |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Humana Medicare |
$740.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
LAYER CLOSURE OF WOUNDS
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 12036
|
| Hospital Charge Code |
40019864
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
LCKNG SCREW 2.5MMX12MM HEXA DRV 7
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.75
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
|
LCKNG SCREW 2.5MMX12MM HEXA DRV 7
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202343
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
|
LCKNG SCREW 2.5MMX14MM HEXA DRV 7
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
|
LCKNG SCREW 2.5MMX14MM HEXA DRV 7
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202344
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.75
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
|
LCKNG SCREW 2.5MMX16MM HEXA DRV 7
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
|
LCKNG SCREW 2.5MMX16MM HEXA DRV 7
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202345
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.75
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
|
LCKNG SCREW 2.5MMX20MM HEXA DRV 7
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
|
|
LCKNG SCREW 2.5MMX20MM HEXA DRV 7
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40202346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$115.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$105.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$120.75
|
| Rate for Payer: EmblemHealth Commercial |
$105.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$220.50
|
| Rate for Payer: Group Health Inc Commercial |
$105.00
|
| Rate for Payer: Group Health Inc Medicare |
$73.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$105.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$105.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$136.50
|
|
|
LCM VIRUS AB, IGG
|
Facility
|
OP
|
$32.18
|
|
|
Service Code
|
HCPCS 86727
|
| Hospital Charge Code |
40729857
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.87
|
| Rate for Payer: Aetna Government |
$12.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.01
|
| Rate for Payer: Brighton Health Commercial |
$24.14
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.87
|
| Rate for Payer: EmblemHealth Commercial |
$12.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.45
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.45
|
| Rate for Payer: Group Health Inc Commercial |
$12.87
|
| Rate for Payer: Group Health Inc Medicare |
$12.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12.87
|
| Rate for Payer: Healthfirst QHP |
$12.87
|
| Rate for Payer: Humana Medicare |
$13.13
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare Commercial |
$16.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$11.58
|
|
|
LCM VIRUS AB, IGG
|
Facility
|
IP
|
$32.18
|
|
|
Service Code
|
HCPCS 86727
|
| Hospital Charge Code |
40729857
|
|
Hospital Revenue Code
|
302
|
| Rate for Payer: Cash Price |
$12.87
|
|
|
LCP DHHS IMP CAP
|
Facility
|
OP
|
$547.50
|
|
| Hospital Charge Code |
64904362
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$191.62 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$273.75
|
| Rate for Payer: Aetna Government |
$273.75
|
| Rate for Payer: Brighton Health Commercial |
$410.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$438.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$372.30
|
| Rate for Payer: Group Health Inc Commercial |
$273.75
|
| Rate for Payer: Group Health Inc Medicare |
$191.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.75
|
|
|
LDCT FOR LUNG CA SCREENING
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
41103927
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$64.72 |
| Max. Negotiated Rate |
$193.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$132.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$127.14
|
| Rate for Payer: Aetna Government |
$127.14
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$89.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$89.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$89.00
|
| Rate for Payer: Brighton Health Commercial |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$127.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$193.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$164.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$127.14
|
| Rate for Payer: EmblemHealth Commercial |
$89.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$108.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$108.07
|
| Rate for Payer: Fidelis Essential Plan QHP |
$113.15
|
| Rate for Payer: Fidelis Medicare Advantage |
$127.14
|
| Rate for Payer: Fidelis Qualified Health Plan |
$113.15
|
| Rate for Payer: Group Health Inc Commercial |
$114.43
|
| Rate for Payer: Group Health Inc Medicare |
$114.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$120.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$127.14
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$114.43
|
| Rate for Payer: Healthfirst Medicare Advantage |
$127.14
|
| Rate for Payer: Healthfirst QHP |
$127.14
|
| Rate for Payer: Humana Medicare |
$129.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$127.14
|
| Rate for Payer: United Healthcare Commercial |
$64.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$127.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$101.71
|
| Rate for Payer: Wellcare Medicare |
$120.78
|
|
|
LDCT FOR LUNG CA SCREENING
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
HCPCS 71271 TC
|
| Hospital Charge Code |
41103927
|
|
Hospital Revenue Code
|
352
|
| Rate for Payer: Cash Price |
$127.14
|
|
|
LDH-BF.
|
Facility
|
OP
|
$15.10
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
40602682
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$11.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.04
|
| Rate for Payer: Aetna Government |
$6.04
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.23
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.23
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.23
|
| Rate for Payer: Brighton Health Commercial |
$11.32
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.62
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.04
|
| Rate for Payer: EmblemHealth Commercial |
$6.04
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.38
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.04
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.38
|
| Rate for Payer: Group Health Inc Commercial |
$6.04
|
| Rate for Payer: Group Health Inc Medicare |
$6.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$6.04
|
| Rate for Payer: Healthfirst QHP |
$6.04
|
| Rate for Payer: Humana Medicare |
$6.16
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.04
|
| Rate for Payer: United Healthcare Commercial |
$7.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.04
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.83
|
| Rate for Payer: Wellcare Medicare |
$5.44
|
|
|
LDH-BF.
|
Facility
|
IP
|
$15.10
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
40602682
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$6.04
|
|
|
L&D PROLAP SET
|
Facility
|
OP
|
$697.63
|
|
| Hospital Charge Code |
64903464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$244.17 |
| Max. Negotiated Rate |
$558.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$383.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$348.82
|
| Rate for Payer: Aetna Government |
$348.82
|
| Rate for Payer: Brighton Health Commercial |
$523.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$558.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$474.39
|
| Rate for Payer: Group Health Inc Commercial |
$348.82
|
| Rate for Payer: Group Health Inc Medicare |
$244.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$348.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$348.82
|
|
|
L&D VAGINAL REPAIR TRAY
|
Facility
|
OP
|
$532.35
|
|
| Hospital Charge Code |
64903470
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$186.32 |
| Max. Negotiated Rate |
$425.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$292.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$266.18
|
| Rate for Payer: Aetna Government |
$266.18
|
| Rate for Payer: Brighton Health Commercial |
$399.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$425.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$362.00
|
| Rate for Payer: Group Health Inc Commercial |
$266.18
|
| Rate for Payer: Group Health Inc Medicare |
$186.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$266.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$266.18
|
|
|
LEA ANTIGEN
|
Facility
|
OP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701264
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$415.67
|
| Rate for Payer: Aetna Government |
$415.67
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$290.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$290.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$290.97
|
| Rate for Payer: Brighton Health Commercial |
$643.78
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Cash Price |
$415.67
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$415.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$415.67
|
| Rate for Payer: EmblemHealth Commercial |
$415.67
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$353.32
|
| Rate for Payer: Fidelis Essential Plan QHP |
$369.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$415.67
|
| Rate for Payer: Fidelis Qualified Health Plan |
$369.95
|
| Rate for Payer: Group Health Inc Commercial |
$415.67
|
| Rate for Payer: Group Health Inc Medicare |
$415.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$415.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$415.67
|
| Rate for Payer: Healthfirst QHP |
$415.67
|
| Rate for Payer: Humana Medicare |
$423.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$4.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$415.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$415.67
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$332.54
|
| Rate for Payer: Wellcare Medicare |
$374.10
|
|
|
LEA ANTIGEN
|
Facility
|
IP
|
$858.38
|
|
|
Service Code
|
HCPCS 86905
|
| Hospital Charge Code |
40701264
|
|
Hospital Revenue Code
|
300
|
| Rate for Payer: Cash Price |
$415.67
|
|
|
LEAD, ATRIAL
|
Facility
|
OP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
40203574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$1,732.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$907.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$275.42
|
| Rate for Payer: Aetna Government |
$275.42
|
| Rate for Payer: Brighton Health Commercial |
$990.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$825.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$948.75
|
| Rate for Payer: EmblemHealth Commercial |
$825.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,732.50
|
| Rate for Payer: Group Health Inc Commercial |
$825.00
|
| Rate for Payer: Group Health Inc Medicare |
$577.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$825.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$825.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,072.50
|
|
|
LEAD, ATRIAL
|
Facility
|
IP
|
$1,650.00
|
|
|
Service Code
|
HCPCS C1785
|
| Hospital Charge Code |
40203574
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.00 |
| Max. Negotiated Rate |
$825.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$825.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$825.00
|
|
