|
LIVER-KIDNEY MICROSOMAL AB
|
Facility
|
OP
|
$36.38
|
|
|
Service Code
|
HCPCS 86376
|
| Hospital Charge Code |
40729345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$27.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.55
|
| Rate for Payer: Aetna Government |
$14.55
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$10.18
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$10.18
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$10.18
|
| Rate for Payer: Brighton Health Commercial |
$27.28
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Cash Price |
$14.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.57
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.55
|
| Rate for Payer: EmblemHealth Commercial |
$14.55
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.37
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.95
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.95
|
| Rate for Payer: Group Health Inc Commercial |
$14.55
|
| Rate for Payer: Group Health Inc Medicare |
$14.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.55
|
| Rate for Payer: Healthfirst QHP |
$14.55
|
| Rate for Payer: Humana Medicare |
$14.84
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare Commercial |
$18.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.64
|
| Rate for Payer: Wellcare Medicare |
$13.10
|
|
|
LIVER PROFILE
|
Facility
|
IP
|
$20.43
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
40602510
|
|
Hospital Revenue Code
|
301
|
| Rate for Payer: Cash Price |
$8.17
|
|
|
LIVER PROFILE
|
Facility
|
OP
|
$20.43
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
40602510
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$15.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.17
|
| Rate for Payer: Aetna Government |
$8.17
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$5.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$5.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$5.72
|
| Rate for Payer: Brighton Health Commercial |
$15.32
|
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Cash Price |
$8.17
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$8.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.98
|
| Rate for Payer: Elderplan Medicare Advantage |
$8.17
|
| Rate for Payer: EmblemHealth Commercial |
$8.17
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$6.94
|
| Rate for Payer: Fidelis Essential Plan QHP |
$7.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$8.17
|
| Rate for Payer: Fidelis Qualified Health Plan |
$7.27
|
| Rate for Payer: Group Health Inc Commercial |
$8.17
|
| Rate for Payer: Group Health Inc Medicare |
$8.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8.17
|
| Rate for Payer: Healthfirst QHP |
$8.17
|
| Rate for Payer: Humana Medicare |
$8.33
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare Commercial |
$10.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.17
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.54
|
| Rate for Payer: Wellcare Medicare |
$7.35
|
|
|
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT
|
Facility
|
IP
|
$205,830.45
|
|
|
Service Code
|
MSDRG 005
|
| Min. Negotiated Rate |
$70,147.70 |
| Max. Negotiated Rate |
$205,830.45 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$152,610.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$150,855.27
|
| Rate for Payer: Aetna Government |
$150,855.27
|
| Rate for Payer: Brighton Health Commercial |
$150,075.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$153,872.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$178,734.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$147,499.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$143,312.51
|
| Rate for Payer: EmblemHealth Commercial |
$88,751.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$150,855.27
|
| Rate for Payer: Group Health Inc Commercial |
$150,855.27
|
| Rate for Payer: Group Health Inc Medicare |
$150,855.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$150,855.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$70,147.70
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$150,855.27
|
| Rate for Payer: United Healthcare Commercial |
$205,830.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150,855.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$150,855.27
|
| Rate for Payer: Wellcare Medicare |
$143,312.51
|
|
|
LIVER TRANSPLANT WITHOUT MCC
|
Facility
|
IP
|
$96,191.43
|
|
|
Service Code
|
MSDRG 006
|
| Min. Negotiated Rate |
$34,597.39 |
| Max. Negotiated Rate |
$96,191.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$71,320.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$74,402.98
|
| Rate for Payer: Aetna Government |
$74,402.98
|
| Rate for Payer: Brighton Health Commercial |
$70,135.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75,891.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83,528.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68,931.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$70,682.83
|
| Rate for Payer: EmblemHealth Commercial |
$41,476.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$74,402.98
|
| Rate for Payer: Group Health Inc Commercial |
$74,402.98
|
| Rate for Payer: Group Health Inc Medicare |
$74,402.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$74,402.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34,597.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$74,402.98
|
| Rate for Payer: United Healthcare Commercial |
$96,191.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74,402.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$74,402.98
|
| Rate for Payer: Wellcare Medicare |
$70,682.83
|
|
|
LLIOINGUINAL,LLIOHYPOGASTRIC
|
Facility
|
OP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
30305031
|
|
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 |
$799.72
|
| Rate for Payer: Aetna Government |
$799.72
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$559.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$559.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$559.80
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Cash Price |
$799.72
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$799.72
|
| 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 |
$799.72
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$679.76
|
| Rate for Payer: Fidelis Essential Plan QHP |
$711.75
|
| Rate for Payer: Fidelis Medicare Advantage |
$799.72
|
| Rate for Payer: Fidelis Qualified Health Plan |
$711.75
|
| 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 |
$946.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$799.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$679.76
|
| Rate for Payer: Healthfirst QHP |
$799.72
|
| Rate for Payer: Humana Medicare |
$815.71
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$799.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$799.72
|
| Rate for Payer: United Healthcare Commercial |
$222.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$799.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$799.72
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$639.78
|
| Rate for Payer: Wellcare Medicare |
$759.73
|
|
|
LLIOINGUINAL,LLIOHYPOGASTRIC
|
Facility
|
IP
|
$1,893.13
|
|
|
Service Code
|
HCPCS 64425
|
| Hospital Charge Code |
30305031
|
|
Hospital Revenue Code
|
510
|
| Rate for Payer: Cash Price |
$799.72
|
|
|
LLOYD CATHETER
|
Facility
|
OP
|
$72.65
|
|
| Hospital Charge Code |
40203780
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$25.43 |
| Max. Negotiated Rate |
$58.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$39.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36.32
|
| Rate for Payer: Aetna Government |
$36.32
|
| Rate for Payer: Brighton Health Commercial |
$54.49
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$58.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.40
|
| Rate for Payer: Group Health Inc Commercial |
$36.32
|
| Rate for Payer: Group Health Inc Medicare |
$25.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$36.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36.32
|
|
|
L NARROW, LONG DR PLATE
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
|
|
L NARROW, LONG DR PLATE
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201361
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$1,470.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$770.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$840.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$805.00
|
| Rate for Payer: EmblemHealth Commercial |
$700.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,470.00
|
| Rate for Payer: Group Health Inc Commercial |
$700.00
|
| Rate for Payer: Group Health Inc Medicare |
$490.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$910.00
|
|
|
LNG NAIL KIT R2.0,TI,RGHT11X360MM
|
Facility
|
IP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$1,500.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
|
|
LNG NAIL KIT R2.0,TI,RGHT11X360MM
|
Facility
|
OP
|
$3,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201192
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$134.20 |
| Max. Negotiated Rate |
$3,150.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,650.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$1,800.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,500.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,725.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,500.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,150.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,500.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,050.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,500.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,500.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,950.00
|
|
|
LNR CONT VIVACIT-E NEUT LL 40X58
|
Facility
|
OP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,018.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$3,292.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,744.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,155.60
|
| Rate for Payer: EmblemHealth Commercial |
$2,744.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,762.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,744.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,920.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,567.20
|
|
|
LNR CONT VIVACIT-E NEUT LL 40X58
|
Facility
|
IP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
|
|
LNR CONT VIVACIT-E NEUT LL 40X58
|
Facility
|
OP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204617
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$5,762.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3,018.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$3,292.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,744.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3,155.60
|
| Rate for Payer: EmblemHealth Commercial |
$2,744.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$5,762.40
|
| Rate for Payer: Group Health Inc Commercial |
$2,744.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,920.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,567.20
|
|
|
LNR CONT VIVACIT-E NEUT LL 40X58
|
Facility
|
IP
|
$5,488.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40007536
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,744.00 |
| Max. Negotiated Rate |
$2,744.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,744.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,744.00
|
|
|
LOBECTOMY
|
Facility
|
OP
|
$4,821.77
|
|
|
Service Code
|
HCPCS 32480
|
| Hospital Charge Code |
40042120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.00 |
| Max. Negotiated Rate |
$3,616.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,651.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,615.01
|
| Rate for Payer: Aetna Government |
$1,615.01
|
| Rate for Payer: Brighton Health Commercial |
$3,616.33
|
| 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 |
$2,410.88
|
| Rate for Payer: Group Health Inc Medicare |
$1,687.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,410.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,410.88
|
| Rate for Payer: United Healthcare Commercial |
$1,496.00
|
|
|
LOCAL ANESTHESIA
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS D9215
|
| Hospital Charge Code |
42302300
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.55
|
| Rate for Payer: Aetna Government |
$8.55
|
| Rate for Payer: Brighton Health Commercial |
$42.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.76
|
| Rate for Payer: Group Health Inc Commercial |
$28.50
|
| Rate for Payer: Group Health Inc Medicare |
$19.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.50
|
|
|
LOCAL ANESTHESIA NOT IN CONJUNC W
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS D9210
|
| Hospital Charge Code |
42302285
|
|
Hospital Revenue Code
|
379
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.61
|
| Rate for Payer: Aetna Government |
$10.61
|
| Rate for Payer: Brighton Health Commercial |
$22.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.40
|
| Rate for Payer: Group Health Inc Commercial |
$15.00
|
| Rate for Payer: Group Health Inc Medicare |
$10.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$15.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$15.00
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC
|
Facility
|
IP
|
$47,972.75
|
|
|
Service Code
|
MSDRG 496
|
| Min. Negotiated Rate |
$16,223.51 |
| Max. Negotiated Rate |
$47,972.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,305.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,889.27
|
| Rate for Payer: Aetna Government |
$34,889.27
|
| Rate for Payer: Brighton Health Commercial |
$28,818.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,587.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,322.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,324.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,144.81
|
| Rate for Payer: EmblemHealth Commercial |
$17,042.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,889.27
|
| Rate for Payer: Group Health Inc Commercial |
$34,889.27
|
| Rate for Payer: Group Health Inc Medicare |
$34,889.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,889.27
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,223.51
|
| Rate for Payer: Humana Medicare |
$47,972.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,889.27
|
| Rate for Payer: United Healthcare Commercial |
$39,525.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,889.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,889.27
|
| Rate for Payer: Wellcare Medicare |
$33,144.81
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC
|
Facility
|
IP
|
$78,360.86
|
|
|
Service Code
|
MSDRG 495
|
| Min. Negotiated Rate |
$26,500.22 |
| Max. Negotiated Rate |
$78,360.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52,804.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56,989.72
|
| Rate for Payer: Aetna Government |
$56,989.72
|
| Rate for Payer: Brighton Health Commercial |
$51,927.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58,129.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61,843.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51,036.11
|
| Rate for Payer: Elderplan Medicare Advantage |
$54,140.23
|
| Rate for Payer: EmblemHealth Commercial |
$30,708.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$56,989.72
|
| Rate for Payer: Group Health Inc Commercial |
$56,989.72
|
| Rate for Payer: Group Health Inc Medicare |
$56,989.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56,989.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,500.22
|
| Rate for Payer: Humana Medicare |
$78,360.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56,989.72
|
| Rate for Payer: United Healthcare Commercial |
$71,219.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56,989.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56,989.72
|
| Rate for Payer: Wellcare Medicare |
$54,140.23
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$37,292.94
|
|
|
Service Code
|
MSDRG 497
|
| Min. Negotiated Rate |
$12,240.00 |
| Max. Negotiated Rate |
$37,292.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,047.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,122.14
|
| Rate for Payer: Aetna Government |
$27,122.14
|
| Rate for Payer: Brighton Health Commercial |
$20,697.30
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,664.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,649.77
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,342.05
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,766.03
|
| Rate for Payer: EmblemHealth Commercial |
$12,240.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,122.14
|
| Rate for Payer: Group Health Inc Commercial |
$27,122.14
|
| Rate for Payer: Group Health Inc Medicare |
$27,122.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,122.14
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,611.80
|
| Rate for Payer: Humana Medicare |
$37,292.94
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,122.14
|
| Rate for Payer: United Healthcare Commercial |
$28,386.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,122.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,122.14
|
| Rate for Payer: Wellcare Medicare |
$25,766.03
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC
|
Facility
|
IP
|
$59,861.42
|
|
|
Service Code
|
MSDRG 498
|
| Min. Negotiated Rate |
$20,244.04 |
| Max. Negotiated Rate |
$59,861.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$38,499.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$43,535.58
|
| Rate for Payer: Aetna Government |
$43,535.58
|
| Rate for Payer: Brighton Health Commercial |
$37,859.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$44,406.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45,089.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$37,209.67
|
| Rate for Payer: Elderplan Medicare Advantage |
$41,358.80
|
| Rate for Payer: EmblemHealth Commercial |
$22,389.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$43,535.58
|
| Rate for Payer: Group Health Inc Commercial |
$43,535.58
|
| Rate for Payer: Group Health Inc Medicare |
$43,535.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43,535.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20,244.04
|
| Rate for Payer: Humana Medicare |
$59,861.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$43,535.58
|
| Rate for Payer: United Healthcare Commercial |
$51,924.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,535.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$43,535.58
|
| Rate for Payer: Wellcare Medicare |
$41,358.80
|
|
|
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC
|
Facility
|
IP
|
$34,669.22
|
|
|
Service Code
|
MSDRG 499
|
| Min. Negotiated Rate |
$11,060.00 |
| Max. Negotiated Rate |
$34,669.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,018.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,213.98
|
| Rate for Payer: Aetna Government |
$25,213.98
|
| Rate for Payer: Brighton Health Commercial |
$18,702.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$25,718.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,273.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,381.09
|
| Rate for Payer: Elderplan Medicare Advantage |
$23,953.28
|
| Rate for Payer: EmblemHealth Commercial |
$11,060.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,213.98
|
| Rate for Payer: Group Health Inc Commercial |
$25,213.98
|
| Rate for Payer: Group Health Inc Medicare |
$25,213.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,213.98
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,724.50
|
| Rate for Payer: Humana Medicare |
$34,669.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,213.98
|
| Rate for Payer: United Healthcare Commercial |
$25,650.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,213.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,213.98
|
| Rate for Payer: Wellcare Medicare |
$23,953.28
|
|
|
LOCATOR NERVE SURGICAL
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
64902887
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$116.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$80.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73.00
|
| Rate for Payer: Aetna Government |
$73.00
|
| Rate for Payer: Brighton Health Commercial |
$109.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$116.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$99.28
|
| Rate for Payer: Group Health Inc Commercial |
$73.00
|
| Rate for Payer: Group Health Inc Medicare |
$51.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$73.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73.00
|
|
