|
LIGACLIP ERCA LARGE 12MM
|
Facility
|
OP
|
$233.03
|
|
| Hospital Charge Code |
64904292
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.56 |
| Max. Negotiated Rate |
$186.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$128.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.52
|
| Rate for Payer: Aetna Government |
$116.52
|
| Rate for Payer: Brighton Health Commercial |
$174.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$186.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.46
|
| Rate for Payer: Group Health Inc Commercial |
$116.52
|
| Rate for Payer: Group Health Inc Medicare |
$81.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.52
|
|
|
LIGACLIP LG
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
40200494
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Brighton Health Commercial |
$7.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
LIGAMAX-5MM ENDO CLIP APPLIER
|
Facility
|
OP
|
$392.98
|
|
| Hospital Charge Code |
64905191
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.54 |
| Max. Negotiated Rate |
$314.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$216.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$196.49
|
| Rate for Payer: Aetna Government |
$196.49
|
| Rate for Payer: Brighton Health Commercial |
$294.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$314.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$267.23
|
| Rate for Payer: Group Health Inc Commercial |
$196.49
|
| Rate for Payer: Group Health Inc Medicare |
$137.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$196.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$196.49
|
|
|
LIGASURE
|
Facility
|
OP
|
$6,746.85
|
|
| Hospital Charge Code |
40203103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,361.40 |
| Max. Negotiated Rate |
$5,397.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,710.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,373.42
|
| Rate for Payer: Aetna Government |
$3,373.42
|
| Rate for Payer: Brighton Health Commercial |
$5,060.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5,397.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4,587.86
|
| Rate for Payer: Group Health Inc Commercial |
$3,373.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,361.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,373.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,373.42
|
|
|
LIGASURE EXACT
|
Facility
|
OP
|
$1,350.93
|
|
| Hospital Charge Code |
64907083
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$472.83 |
| Max. Negotiated Rate |
$1,080.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$743.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$675.46
|
| Rate for Payer: Aetna Government |
$675.46
|
| Rate for Payer: Brighton Health Commercial |
$1,013.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,080.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$918.63
|
| Rate for Payer: Group Health Inc Commercial |
$675.46
|
| Rate for Payer: Group Health Inc Medicare |
$472.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$675.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$675.46
|
|
|
LIGASURE PRECISE
|
Facility
|
OP
|
$582.00
|
|
| Hospital Charge Code |
40209558
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$465.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$320.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$291.00
|
| Rate for Payer: Aetna Government |
$291.00
|
| Rate for Payer: Brighton Health Commercial |
$436.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$465.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$395.76
|
| Rate for Payer: Group Health Inc Commercial |
$291.00
|
| Rate for Payer: Group Health Inc Medicare |
$203.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$291.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$291.00
|
|
|
LIGATE FALLOPIAN TUBE W CESARIAN
|
Facility
|
OP
|
$1,341.68
|
|
|
Service Code
|
HCPCS 58611
|
| Hospital Charge Code |
40052236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$737.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$94.90
|
| Rate for Payer: Aetna Government |
$94.90
|
| Rate for Payer: Brighton Health Commercial |
$1,006.26
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$670.84
|
| Rate for Payer: Group Health Inc Medicare |
$469.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$670.84
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$670.84
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
LIGATE FALLOP TUBE, ABD/VAG, POST
|
Facility
|
OP
|
$894.45
|
|
|
Service Code
|
HCPCS 58605
|
| Hospital Charge Code |
40052243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$313.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$491.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$404.99
|
| Rate for Payer: Aetna Government |
$404.99
|
| Rate for Payer: Brighton Health Commercial |
$670.84
|
| 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: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Group Health Inc Commercial |
$447.22
|
| Rate for Payer: Group Health Inc Medicare |
$313.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$447.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$447.22
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
|
|
LIGATIONN OF HEMRRHOID(S)
|
Facility
|
IP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
30105535
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$1,056.92
|
|
|
LIGATIONN OF HEMRRHOID(S)
|
Facility
|
OP
|
$2,313.60
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
30105535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$780.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,056.92
|
| Rate for Payer: Aetna Government |
$1,056.92
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$739.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$739.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$739.84
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Cash Price |
$1,056.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,056.92
|
| 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 |
$1,056.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$898.38
|
| Rate for Payer: Fidelis Essential Plan QHP |
$940.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,056.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$940.66
|
| 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 |
$1,156.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,056.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$898.38
|
| Rate for Payer: Healthfirst QHP |
$1,056.92
|
| Rate for Payer: Humana Medicare |
$1,078.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,056.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,056.92
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,056.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,056.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$845.54
|
| Rate for Payer: Wellcare Medicare |
$1,004.07
|
|
|
LIGATION OF A-V FISTULA
|
Facility
|
OP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
40034108
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,505.00 |
| Max. Negotiated Rate |
$6,295.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,686.08
|
| Rate for Payer: Aetna Government |
$3,686.08
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,580.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,580.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,580.26
|
| Rate for Payer: Brighton Health Commercial |
$6,295.15
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Cash Price |
$3,686.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,686.08
|
| 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 |
$3,686.08
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,133.17
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,280.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,686.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,280.61
|
| Rate for Payer: Group Health Inc Commercial |
$3,686.08
|
| Rate for Payer: Group Health Inc Medicare |
$3,686.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,196.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,686.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,133.17
|
| Rate for Payer: Healthfirst QHP |
$3,686.08
|
| Rate for Payer: Humana Medicare |
$3,759.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,686.08
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,686.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,686.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,948.86
|
| Rate for Payer: Wellcare Medicare |
$3,501.78
|
|
|
LIGATION OF A-V FISTULA
|
Facility
|
IP
|
$8,393.53
|
|
|
Service Code
|
HCPCS 37607
|
| Hospital Charge Code |
40034108
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,686.08
|
|
|
LIGATION OF HEMORRHOIDS MULTI PRO
|
Facility
|
IP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
40019462
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,246.99
|
|
|
LIGATION OF HEMORRHOIDS MULTI PRO
|
Facility
|
OP
|
$7,099.93
|
|
|
Service Code
|
HCPCS 46946
|
| Hospital Charge Code |
40019462
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,412.00 |
| Max. Negotiated Rate |
$5,324.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,246.99
|
| Rate for Payer: Aetna Government |
$3,246.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,272.89
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,272.89
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,272.89
|
| Rate for Payer: Brighton Health Commercial |
$5,324.95
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Cash Price |
$3,246.99
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,246.99
|
| 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 |
$3,246.99
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,759.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,889.82
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,246.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,889.82
|
| Rate for Payer: Group Health Inc Commercial |
$3,246.99
|
| Rate for Payer: Group Health Inc Medicare |
$3,246.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,549.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,246.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,759.94
|
| Rate for Payer: Healthfirst QHP |
$3,246.99
|
| Rate for Payer: Humana Medicare |
$3,311.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,246.99
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,246.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,246.99
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,597.59
|
| Rate for Payer: Wellcare Medicare |
$3,084.64
|
|
|
Ligation or biopsy, temporal artery
|
Facility
|
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 37609
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,312.42 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,874.89
|
| Rate for Payer: Aetna Government |
$1,874.89
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$1,312.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$1,312.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$1,312.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,874.89
|
| 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 |
$1,874.89
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$1,593.66
|
| Rate for Payer: Fidelis Essential Plan QHP |
$1,668.65
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,874.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$1,668.65
|
| Rate for Payer: Group Health Inc Commercial |
$1,874.89
|
| Rate for Payer: Group Health Inc Medicare |
$1,874.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,874.89
|
| Rate for Payer: Healthfirst Medicare Advantage |
$1,593.66
|
| Rate for Payer: Healthfirst QHP |
$1,874.89
|
| Rate for Payer: Humana Medicare |
$1,912.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,874.89
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,874.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,874.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,499.91
|
| Rate for Payer: Wellcare Medicare |
$1,781.15
|
|
|
LIGATOR SAEED MULTIBAND SIX SHTER
|
Facility
|
OP
|
$637.50
|
|
| Hospital Charge Code |
64904418
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$223.12 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$350.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$318.75
|
| Rate for Payer: Aetna Government |
$318.75
|
| Rate for Payer: Brighton Health Commercial |
$478.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$510.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$433.50
|
| Rate for Payer: Group Health Inc Commercial |
$318.75
|
| Rate for Payer: Group Health Inc Medicare |
$223.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$318.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$318.75
|
|
|
LIGATOR SUPER 7 SPEEDBAND
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
40205961
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$374.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$340.00
|
| Rate for Payer: Aetna Government |
$340.00
|
| Rate for Payer: Brighton Health Commercial |
$510.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$544.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$462.40
|
| Rate for Payer: Group Health Inc Commercial |
$340.00
|
| Rate for Payer: Group Health Inc Medicare |
$238.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$340.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$340.00
|
|
|
LIGATOR SUPER 7 SPEEDBAND 2.8MM
|
Facility
|
OP
|
$859.35
|
|
| Hospital Charge Code |
64903217
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$300.77 |
| Max. Negotiated Rate |
$687.48 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$472.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$429.68
|
| Rate for Payer: Aetna Government |
$429.68
|
| Rate for Payer: Brighton Health Commercial |
$644.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$687.48
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$584.36
|
| Rate for Payer: Group Health Inc Commercial |
$429.68
|
| Rate for Payer: Group Health Inc Medicare |
$300.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$429.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$429.68
|
|
|
LIMB EXTENSION
|
Facility
|
OP
|
$5,190.00
|
|
| Hospital Charge Code |
40202227
|
|
Hospital Revenue Code
|
279
|
| Min. Negotiated Rate |
$1,816.50 |
| Max. Negotiated Rate |
$4,152.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,854.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,595.00
|
| Rate for Payer: Aetna Government |
$2,595.00
|
| Rate for Payer: Brighton Health Commercial |
$3,892.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4,152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,529.20
|
| Rate for Payer: Group Health Inc Commercial |
$2,595.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,816.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,595.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,595.00
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$84,023.95
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$28,415.37 |
| Max. Negotiated Rate |
$84,023.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$57,184.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$61,108.33
|
| Rate for Payer: Aetna Government |
$61,108.33
|
| Rate for Payer: Brighton Health Commercial |
$56,233.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62,330.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$66,972.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$55,268.69
|
| Rate for Payer: Elderplan Medicare Advantage |
$58,052.91
|
| Rate for Payer: EmblemHealth Commercial |
$33,255.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$61,108.33
|
| Rate for Payer: Group Health Inc Commercial |
$61,108.33
|
| Rate for Payer: Group Health Inc Medicare |
$61,108.33
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$61,108.33
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,415.37
|
| Rate for Payer: Humana Medicare |
$84,023.95
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$61,108.33
|
| Rate for Payer: United Healthcare Commercial |
$77,125.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61,108.33
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$61,108.33
|
| Rate for Payer: Wellcare Medicare |
$58,052.91
|
|
|
LIMITED ORAL EVALUATION
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
HCPCS D0140
|
| Hospital Charge Code |
42303271
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$17.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$152.87
|
| Rate for Payer: Aetna Government |
$152.87
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$107.01
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$107.01
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$107.01
|
| Rate for Payer: Brighton Health Commercial |
$26.25
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Cash Price |
$152.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$152.87
|
| 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 |
$152.87
|
| Rate for Payer: EmblemHealth Commercial |
$152.87
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$129.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$136.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$152.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$136.05
|
| Rate for Payer: Group Health Inc Commercial |
$152.87
|
| Rate for Payer: Group Health Inc Medicare |
$152.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$152.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$129.94
|
| Rate for Payer: Healthfirst QHP |
$152.87
|
| Rate for Payer: Humana Medicare |
$155.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$152.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$152.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$122.30
|
| Rate for Payer: Wellcare Medicare |
$145.23
|
|
|
LIMITED ORAL EVALUATION
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
HCPCS D0140
|
| Hospital Charge Code |
42303271
|
|
Hospital Revenue Code
|
361
|
| Rate for Payer: Cash Price |
$152.87
|
|
|
LINDANE 1 % EX SHAM [4498]
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 60432083460
|
| Hospital Charge Code |
60432083460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.14
|
| Rate for Payer: Aetna Government |
$1.14
|
| Rate for Payer: Brighton Health Commercial |
$1.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.55
|
| Rate for Payer: Group Health Inc Commercial |
$1.14
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.48
|
|
|
LINDANE 1% SHAMPOO
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
41645249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna Government |
$110.00
|
| Rate for Payer: Brighton Health Commercial |
$165.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.60
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
|
LINDANE 1% SHAMPOO
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
41655249
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$110.00
|
| Rate for Payer: Aetna Government |
$110.00
|
| Rate for Payer: Brighton Health Commercial |
$165.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$176.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$149.60
|
| Rate for Payer: Group Health Inc Commercial |
$110.00
|
| Rate for Payer: Group Health Inc Medicare |
$77.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$110.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$110.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$143.00
|
|
