|
AMPUTATION, FINGER/THUMB
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
40064081
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
AMPUTATION, FINGER/THUMB
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
40064081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,409.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION FOLLOW UP SURGERY
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25931
|
| Hospital Charge Code |
40009453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,134.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION FOLLOW UP SURGERY
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 25931
|
| Hospital Charge Code |
40009453
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
AMPUTATION FOOT (CHOPART TYPE)
|
Facility
|
OP
|
$1,638.45
|
|
|
Service Code
|
HCPCS 28800
|
| Hospital Charge Code |
40019927
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$551.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$901.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$551.07
|
| Rate for Payer: Aetna Government |
$551.07
|
| Rate for Payer: Brighton Health Commercial |
$1,228.84
|
| 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 |
$819.22
|
| Rate for Payer: Group Health Inc Medicare |
$573.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$819.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$819.22
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
AMPUTATION FOOT TRANSMATATARSAL
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
40029830
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
AMPUTATION FOOT TRANSMATATARSAL
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28805
|
| Hospital Charge Code |
40029830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$63,640.62
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$21,522.10 |
| Max. Negotiated Rate |
$63,640.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41,421.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46,284.09
|
| Rate for Payer: Aetna Government |
$46,284.09
|
| Rate for Payer: Brighton Health Commercial |
$40,733.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47,209.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$48,512.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40,034.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$43,969.89
|
| Rate for Payer: EmblemHealth Commercial |
$24,088.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$46,284.09
|
| Rate for Payer: Group Health Inc Commercial |
$46,284.09
|
| Rate for Payer: Group Health Inc Medicare |
$46,284.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46,284.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,522.10
|
| Rate for Payer: Humana Medicare |
$63,640.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46,284.09
|
| Rate for Payer: United Healthcare Commercial |
$55,866.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,284.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46,284.09
|
| Rate for Payer: Wellcare Medicare |
$43,969.89
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$101,730.19
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$34,403.30 |
| Max. Negotiated Rate |
$101,730.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$70,876.27
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$73,985.59
|
| Rate for Payer: Aetna Government |
$73,985.59
|
| Rate for Payer: Brighton Health Commercial |
$69,698.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$75,465.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$83,008.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$68,502.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$70,286.31
|
| Rate for Payer: EmblemHealth Commercial |
$41,218.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$73,985.59
|
| Rate for Payer: Group Health Inc Commercial |
$73,985.59
|
| Rate for Payer: Group Health Inc Medicare |
$73,985.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$73,985.59
|
| Rate for Payer: Healthfirst Medicare Advantage |
$34,403.30
|
| Rate for Payer: Humana Medicare |
$101,730.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$73,985.59
|
| Rate for Payer: United Healthcare Commercial |
$95,592.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73,985.59
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73,985.59
|
| Rate for Payer: Wellcare Medicare |
$70,286.31
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$36,656.07
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$11,917.50 |
| Max. Negotiated Rate |
$36,656.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,492.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,658.96
|
| Rate for Payer: Aetna Government |
$26,658.96
|
| Rate for Payer: Brighton Health Commercial |
$20,152.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,192.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,072.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,866.06
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,326.01
|
| Rate for Payer: EmblemHealth Commercial |
$11,917.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,658.96
|
| Rate for Payer: Group Health Inc Commercial |
$26,658.96
|
| Rate for Payer: Group Health Inc Medicare |
$26,658.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,658.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,396.42
|
| Rate for Payer: Humana Medicare |
$36,656.07
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,658.96
|
| Rate for Payer: United Healthcare Commercial |
$27,722.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,658.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,658.96
|
| Rate for Payer: Wellcare Medicare |
$25,326.01
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$50,970.20
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$17,237.20 |
| Max. Negotiated Rate |
$50,970.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,623.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,069.24
|
| Rate for Payer: Aetna Government |
$37,069.24
|
| Rate for Payer: Brighton Health Commercial |
$31,098.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,810.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,036.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,564.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$35,215.78
|
| Rate for Payer: EmblemHealth Commercial |
$18,390.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,069.24
|
| Rate for Payer: Group Health Inc Commercial |
$37,069.24
|
| Rate for Payer: Group Health Inc Medicare |
$37,069.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,069.24
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,237.20
|
| Rate for Payer: Humana Medicare |
$50,970.20
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,069.24
|
| Rate for Payer: United Healthcare Commercial |
$42,651.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,069.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,069.24
|
| Rate for Payer: Wellcare Medicare |
$35,215.78
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$92,120.08
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$31,153.34 |
| Max. Negotiated Rate |
$92,120.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63,444.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$66,996.42
|
| Rate for Payer: Aetna Government |
$66,996.42
|
| Rate for Payer: Brighton Health Commercial |
$62,390.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$68,336.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74,305.05
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61,319.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$63,646.60
|
| Rate for Payer: EmblemHealth Commercial |
$36,896.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$66,996.42
|
| Rate for Payer: Group Health Inc Commercial |
$66,996.42
|
| Rate for Payer: Group Health Inc Medicare |
$66,996.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$66,996.42
|
| Rate for Payer: Healthfirst Medicare Advantage |
$31,153.34
|
| Rate for Payer: Humana Medicare |
$92,120.08
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$66,996.42
|
| Rate for Payer: United Healthcare Commercial |
$85,569.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66,996.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66,996.42
|
| Rate for Payer: Wellcare Medicare |
$63,646.60
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$32,516.52
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$10,091.90 |
| Max. Negotiated Rate |
$32,516.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,353.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,648.38
|
| Rate for Payer: Aetna Government |
$23,648.38
|
| Rate for Payer: Brighton Health Commercial |
$17,065.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,121.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,323.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,772.14
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,465.96
|
| Rate for Payer: EmblemHealth Commercial |
$10,091.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,648.38
|
| Rate for Payer: Group Health Inc Commercial |
$23,648.38
|
| Rate for Payer: Group Health Inc Medicare |
$23,648.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,648.38
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,996.50
|
| Rate for Payer: Humana Medicare |
$32,516.52
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,648.38
|
| Rate for Payer: United Healthcare Commercial |
$23,405.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,648.38
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,648.38
|
| Rate for Payer: Wellcare Medicare |
$22,465.96
|
|
|
AMPUTATION-HAND
|
Facility
|
OP
|
$3,118.90
|
|
|
Service Code
|
HCPCS 25927
|
| Hospital Charge Code |
40011145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.04 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,715.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$835.04
|
| Rate for Payer: Aetna Government |
$835.04
|
| Rate for Payer: Brighton Health Commercial |
$2,339.18
|
| 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 |
$1,559.45
|
| Rate for Payer: Group Health Inc Medicare |
$1,091.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,559.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,559.45
|
| Rate for Payer: United Healthcare Commercial |
$1,835.00
|
|
|
AMPUTATION OF FINGER OR THUMB
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
30107810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$4,145.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$874.00
|
| Rate for Payer: Carelon Behavioral Health CHP/Medicaid |
$3,743.15
|
| Rate for Payer: Carelon Behavioral Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$525.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$525.00
|
| Rate for Payer: Group Health Inc Medicare |
$525.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$165.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$225.00
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$3,743.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$569.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION OF FINGER OR THUMB
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 26951
|
| Hospital Charge Code |
30107810
|
|
Hospital Revenue Code
|
450
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$47,915.55
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$16,204.17 |
| Max. Negotiated Rate |
$47,915.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,261.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,847.67
|
| Rate for Payer: Aetna Government |
$34,847.67
|
| Rate for Payer: Brighton Health Commercial |
$28,775.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,544.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,270.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,281.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,105.29
|
| Rate for Payer: EmblemHealth Commercial |
$17,017.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,847.67
|
| Rate for Payer: Group Health Inc Commercial |
$34,847.67
|
| Rate for Payer: Group Health Inc Medicare |
$34,847.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,847.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,204.17
|
| Rate for Payer: Humana Medicare |
$47,915.55
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,847.67
|
| Rate for Payer: United Healthcare Commercial |
$39,465.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,847.67
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,847.67
|
| Rate for Payer: Wellcare Medicare |
$33,105.29
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$85,539.82
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$28,928.01 |
| Max. Negotiated Rate |
$85,539.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$58,356.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62,210.78
|
| Rate for Payer: Aetna Government |
$62,210.78
|
| Rate for Payer: Brighton Health Commercial |
$57,386.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$63,455.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68,345.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$56,401.66
|
| Rate for Payer: Elderplan Medicare Advantage |
$59,100.24
|
| Rate for Payer: EmblemHealth Commercial |
$33,937.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$62,210.78
|
| Rate for Payer: Group Health Inc Commercial |
$62,210.78
|
| Rate for Payer: Group Health Inc Medicare |
$62,210.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62,210.78
|
| Rate for Payer: Healthfirst Medicare Advantage |
$28,928.01
|
| Rate for Payer: Humana Medicare |
$85,539.82
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62,210.78
|
| Rate for Payer: United Healthcare Commercial |
$78,706.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62,210.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62,210.78
|
| Rate for Payer: Wellcare Medicare |
$59,100.24
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$32,222.88
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$9,959.86 |
| Max. Negotiated Rate |
$32,222.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,126.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23,434.82
|
| Rate for Payer: Aetna Government |
$23,434.82
|
| Rate for Payer: Brighton Health Commercial |
$16,841.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$23,903.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,057.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16,552.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,263.08
|
| Rate for Payer: EmblemHealth Commercial |
$9,959.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,434.82
|
| Rate for Payer: Group Health Inc Commercial |
$23,434.82
|
| Rate for Payer: Group Health Inc Medicare |
$23,434.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23,434.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,897.19
|
| Rate for Payer: Humana Medicare |
$32,222.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$23,434.82
|
| Rate for Payer: United Healthcare Commercial |
$23,098.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,434.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$23,434.82
|
| Rate for Payer: Wellcare Medicare |
$22,263.08
|
|
|
AMPUTATION - TOE
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
40031825
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
AMPUTATION - TOE
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
40031825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION TOE/1
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
40082590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION TOE/1
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
40082590
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
|
AMPUTATION - TRANSMETATARSAL
|
Facility
|
OP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
40031830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,468.00 |
| Max. Negotiated Rate |
$6,218.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,743.15
|
| Rate for Payer: Aetna Government |
$3,743.15
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$2,620.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$2,620.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$2,620.20
|
| Rate for Payer: Brighton Health Commercial |
$6,218.29
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Cash Price |
$3,743.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,743.15
|
| 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 |
$3,743.15
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,181.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,331.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,743.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,331.40
|
| Rate for Payer: Group Health Inc Commercial |
$3,743.15
|
| Rate for Payer: Group Health Inc Medicare |
$3,743.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4,145.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,743.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,181.68
|
| Rate for Payer: Healthfirst QHP |
$3,743.15
|
| Rate for Payer: Humana Medicare |
$3,818.01
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,743.15
|
| Rate for Payer: United Healthcare Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,743.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,743.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,994.52
|
| Rate for Payer: Wellcare Medicare |
$3,555.99
|
|
|
AMPUTATION - TRANSMETATARSAL
|
Facility
|
IP
|
$8,291.05
|
|
|
Service Code
|
HCPCS 28810
|
| Hospital Charge Code |
40031830
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$3,743.15
|
|
