|
NON LOCKING SCREW 2.3 X 14MM
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
40201259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.00
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$29,629.68
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$8,793.66 |
| Max. Negotiated Rate |
$29,629.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,121.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,548.86
|
| Rate for Payer: Aetna Government |
$21,548.86
|
| Rate for Payer: Brighton Health Commercial |
$14,869.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$21,979.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,709.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,614.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,471.42
|
| Rate for Payer: EmblemHealth Commercial |
$8,793.66
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,548.86
|
| Rate for Payer: Group Health Inc Commercial |
$21,548.86
|
| Rate for Payer: Group Health Inc Medicare |
$21,548.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,548.86
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,020.22
|
| Rate for Payer: Humana Medicare |
$29,629.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,548.86
|
| Rate for Payer: United Healthcare Commercial |
$20,394.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,548.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,548.86
|
| Rate for Payer: Wellcare Medicare |
$20,471.42
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,155.14
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$5,338.80 |
| Max. Negotiated Rate |
$22,155.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,180.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,112.83
|
| Rate for Payer: Aetna Government |
$16,112.83
|
| Rate for Payer: Brighton Health Commercial |
$9,027.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,435.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10,939.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,028.08
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,307.19
|
| Rate for Payer: EmblemHealth Commercial |
$5,338.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,112.83
|
| Rate for Payer: Group Health Inc Commercial |
$16,112.83
|
| Rate for Payer: Group Health Inc Medicare |
$16,112.83
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,112.83
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,492.47
|
| Rate for Payer: Humana Medicare |
$22,155.14
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,112.83
|
| Rate for Payer: United Healthcare Commercial |
$12,598.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,112.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,112.83
|
| Rate for Payer: Wellcare Medicare |
$15,307.19
|
|
|
NONPRESSURIZED INHALATION TREATMT
|
Facility
|
OP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40401400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$132.45 |
| Max. Negotiated Rate |
$417.88 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$246.65
|
| Rate for Payer: Aetna Government |
$246.65
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$172.66
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$172.66
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$172.66
|
| Rate for Payer: Brighton Health Commercial |
$417.88
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Cash Price |
$246.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$246.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$155.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$132.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$246.65
|
| Rate for Payer: EmblemHealth Commercial |
$246.65
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$209.65
|
| Rate for Payer: Fidelis Essential Plan QHP |
$219.52
|
| Rate for Payer: Fidelis Medicare Advantage |
$246.65
|
| Rate for Payer: Fidelis Qualified Health Plan |
$219.52
|
| Rate for Payer: Group Health Inc Commercial |
$246.65
|
| Rate for Payer: Group Health Inc Medicare |
$246.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$246.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$209.65
|
| Rate for Payer: Healthfirst QHP |
$246.65
|
| Rate for Payer: Humana Medicare |
$251.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$246.65
|
| Rate for Payer: United Healthcare Commercial |
$278.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$246.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$246.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$197.32
|
| Rate for Payer: Wellcare Medicare |
$234.32
|
|
|
NONPRESSURIZED INHALATION TREATMT
|
Facility
|
IP
|
$557.18
|
|
|
Service Code
|
HCPCS 94640
|
| Hospital Charge Code |
40401400
|
|
Hospital Revenue Code
|
410
|
| Rate for Payer: Cash Price |
$246.65
|
|
|
NON-SELECTIVE WOUNDCARE
|
Facility
|
IP
|
$529.23
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
42500188
|
|
Hospital Revenue Code
|
761
|
| Rate for Payer: Cash Price |
$231.52
|
|
|
NON-SELECTIVE WOUNDCARE
|
Facility
|
OP
|
$529.23
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
42500188
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$162.06 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$291.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$231.52
|
| Rate for Payer: Aetna Government |
$231.52
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$162.06
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$162.06
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$162.06
|
| Rate for Payer: Brighton Health Commercial |
$396.92
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Cash Price |
$231.52
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$231.52
|
| 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 |
$231.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$196.79
|
| Rate for Payer: Fidelis Essential Plan QHP |
$206.05
|
| Rate for Payer: Fidelis Medicare Advantage |
$231.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$206.05
|
| 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 |
$264.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$231.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$196.79
|
| Rate for Payer: Healthfirst QHP |
$231.52
|
| Rate for Payer: Humana Medicare |
$236.15
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$231.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$231.52
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$231.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$185.22
|
| Rate for Payer: Wellcare Medicare |
$219.94
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$30,321.80
|
|
|
Service Code
|
MSDRG 071
|
| Min. Negotiated Rate |
$9,104.94 |
| Max. Negotiated Rate |
$30,321.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,656.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,052.22
|
| Rate for Payer: Aetna Government |
$22,052.22
|
| Rate for Payer: Brighton Health Commercial |
$15,396.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,493.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,336.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,131.84
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,949.61
|
| Rate for Payer: EmblemHealth Commercial |
$9,104.94
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,052.22
|
| Rate for Payer: Group Health Inc Commercial |
$22,052.22
|
| Rate for Payer: Group Health Inc Medicare |
$22,052.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,052.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,254.28
|
| Rate for Payer: Humana Medicare |
$30,321.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,052.22
|
| Rate for Payer: United Healthcare Commercial |
$21,116.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,052.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,052.22
|
| Rate for Payer: Wellcare Medicare |
$20,949.61
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$44,197.35
|
|
|
Service Code
|
MSDRG 070
|
| Min. Negotiated Rate |
$14,946.74 |
| Max. Negotiated Rate |
$44,197.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,386.18
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,143.53
|
| Rate for Payer: Aetna Government |
$32,143.53
|
| Rate for Payer: Brighton Health Commercial |
$25,947.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$32,786.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30,902.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25,502.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$30,536.35
|
| Rate for Payer: EmblemHealth Commercial |
$15,345.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,143.53
|
| Rate for Payer: Group Health Inc Commercial |
$32,143.53
|
| Rate for Payer: Group Health Inc Medicare |
$32,143.53
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,143.53
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14,946.74
|
| Rate for Payer: Humana Medicare |
$44,197.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,143.53
|
| Rate for Payer: United Healthcare Commercial |
$35,587.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,143.53
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,143.53
|
| Rate for Payer: Wellcare Medicare |
$30,536.35
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$25,005.75
|
|
|
Service Code
|
MSDRG 072
|
| Min. Negotiated Rate |
$6,714.23 |
| Max. Negotiated Rate |
$25,005.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11,545.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18,186.00
|
| Rate for Payer: Aetna Government |
$18,186.00
|
| Rate for Payer: Brighton Health Commercial |
$11,353.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$18,549.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13,521.63
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11,158.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$17,276.70
|
| Rate for Payer: EmblemHealth Commercial |
$6,714.23
|
| Rate for Payer: Fidelis Medicare Advantage |
$18,186.00
|
| Rate for Payer: Group Health Inc Commercial |
$18,186.00
|
| Rate for Payer: Group Health Inc Medicare |
$18,186.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18,186.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$8,456.49
|
| Rate for Payer: Humana Medicare |
$25,005.75
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$18,186.00
|
| Rate for Payer: United Healthcare Commercial |
$15,571.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,186.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18,186.00
|
| Rate for Payer: Wellcare Medicare |
$17,276.70
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$37,092.76
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$12,149.90 |
| Max. Negotiated Rate |
$37,092.76 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,892.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,976.55
|
| Rate for Payer: Aetna Government |
$26,976.55
|
| Rate for Payer: Brighton Health Commercial |
$20,545.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,516.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,468.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,192.41
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,627.72
|
| Rate for Payer: EmblemHealth Commercial |
$12,149.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,976.55
|
| Rate for Payer: Group Health Inc Commercial |
$26,976.55
|
| Rate for Payer: Group Health Inc Medicare |
$26,976.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,976.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,544.10
|
| Rate for Payer: Humana Medicare |
$37,092.76
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,976.55
|
| Rate for Payer: United Healthcare Commercial |
$28,177.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,976.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,976.55
|
| Rate for Payer: Wellcare Medicare |
$25,627.72
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$26,683.72
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$7,468.83 |
| Max. Negotiated Rate |
$26,683.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,842.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,406.34
|
| Rate for Payer: Aetna Government |
$19,406.34
|
| Rate for Payer: Brighton Health Commercial |
$12,629.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,794.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,041.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,412.73
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,436.02
|
| Rate for Payer: EmblemHealth Commercial |
$7,468.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,406.34
|
| Rate for Payer: Group Health Inc Commercial |
$19,406.34
|
| Rate for Payer: Group Health Inc Medicare |
$19,406.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,406.34
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,023.95
|
| Rate for Payer: Humana Medicare |
$26,683.72
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,406.34
|
| Rate for Payer: United Healthcare Commercial |
$17,321.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,406.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,406.34
|
| Rate for Payer: Wellcare Medicare |
$18,436.02
|
|
|
NON STRESS TEST
|
Facility
|
IP
|
$502.93
|
|
|
Service Code
|
HCPCS 59025 TC
|
| Hospital Charge Code |
40250400
|
|
Hospital Revenue Code
|
920
|
| Rate for Payer: Cash Price |
$230.44
|
|
|
NON STRESS TEST
|
Facility
|
OP
|
$502.93
|
|
|
Service Code
|
HCPCS 59025 TC
|
| Hospital Charge Code |
40250400
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$342.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$230.44
|
| Rate for Payer: Aetna Government |
$230.44
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$161.31
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$161.31
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$161.31
|
| Rate for Payer: Brighton Health Commercial |
$377.20
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Cash Price |
$230.44
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$230.44
|
| 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 |
$230.44
|
| Rate for Payer: EmblemHealth Commercial |
$230.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$195.87
|
| Rate for Payer: Fidelis Essential Plan QHP |
$205.09
|
| Rate for Payer: Fidelis Medicare Advantage |
$230.44
|
| Rate for Payer: Fidelis Qualified Health Plan |
$205.09
|
| Rate for Payer: Group Health Inc Commercial |
$230.44
|
| Rate for Payer: Group Health Inc Medicare |
$230.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$251.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$230.44
|
| Rate for Payer: Healthfirst Medicare Advantage |
$195.87
|
| Rate for Payer: Healthfirst QHP |
$230.44
|
| Rate for Payer: Humana Medicare |
$235.05
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$230.44
|
| Rate for Payer: United Healthcare Commercial |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$230.44
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$184.35
|
| Rate for Payer: Wellcare Medicare |
$218.92
|
|
|
NON THREADED 6.5X75MM
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$134.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$134.20
|
| Rate for Payer: Aetna Government |
$134.20
|
| Rate for Payer: Brighton Health Commercial |
$36.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$30.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$34.50
|
| Rate for Payer: EmblemHealth Commercial |
$30.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$63.00
|
| Rate for Payer: Group Health Inc Commercial |
$30.00
|
| Rate for Payer: Group Health Inc Medicare |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$39.00
|
|
|
NON THREADED 6.5X75MM
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
64902717
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$30.00
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$52,190.49
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$17,649.87 |
| Max. Negotiated Rate |
$52,190.49 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32,567.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,956.72
|
| Rate for Payer: Aetna Government |
$37,956.72
|
| Rate for Payer: Brighton Health Commercial |
$32,026.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,715.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$38,142.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31,476.45
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,058.88
|
| Rate for Payer: EmblemHealth Commercial |
$18,939.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,956.72
|
| Rate for Payer: Group Health Inc Commercial |
$37,956.72
|
| Rate for Payer: Group Health Inc Medicare |
$37,956.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,956.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,649.87
|
| Rate for Payer: Humana Medicare |
$52,190.49
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,956.72
|
| Rate for Payer: United Healthcare Commercial |
$43,924.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,956.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,956.72
|
| Rate for Payer: Wellcare Medicare |
$36,058.88
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$27,417.80
|
|
|
Service Code
|
MSDRG 081
|
| Min. Negotiated Rate |
$7,798.96 |
| Max. Negotiated Rate |
$27,417.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,410.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,940.22
|
| Rate for Payer: Aetna Government |
$19,940.22
|
| Rate for Payer: Brighton Health Commercial |
$13,187.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,339.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,706.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,961.39
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,943.21
|
| Rate for Payer: EmblemHealth Commercial |
$7,798.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,940.22
|
| Rate for Payer: Group Health Inc Commercial |
$19,940.22
|
| Rate for Payer: Group Health Inc Medicare |
$19,940.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,940.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,272.20
|
| Rate for Payer: Humana Medicare |
$27,417.80
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,940.22
|
| Rate for Payer: United Healthcare Commercial |
$18,087.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,940.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,940.22
|
| Rate for Payer: Wellcare Medicare |
$18,943.21
|
|
|
NOREPHINEPHRINE, 8MG D5W 250ML
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
41647112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
|
NOREPHINEPHRINE, 8MG D5W 250ML
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
41657112
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21.00
|
| Rate for Payer: Aetna Government |
$21.00
|
| Rate for Payer: Brighton Health Commercial |
$31.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28.56
|
| Rate for Payer: Group Health Inc Commercial |
$21.00
|
| Rate for Payer: Group Health Inc Medicare |
$14.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27.30
|
|
|
NOREPHINEPHRINE 8MG/NS 250 KIT
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41649539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
NOREPINEPHINE 8MH/NS PREMIX
|
Facility
|
OP
|
$14.79
|
|
| Hospital Charge Code |
41656591
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$11.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.40
|
| Rate for Payer: Aetna Government |
$7.40
|
| Rate for Payer: Brighton Health Commercial |
$11.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.06
|
| Rate for Payer: Group Health Inc Commercial |
$7.40
|
| Rate for Payer: Group Health Inc Medicare |
$5.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.61
|
|
|
NOREPINEPHRINE 4 MG/4 ML INJ
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41653536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
NOREPINEPHRINE 4 MG/4 ML INJ
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41643536
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
NOREPINEPHRINE 8MG/250ML D5W
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
41647143
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.50
|
| Rate for Payer: Aetna Government |
$6.50
|
| Rate for Payer: Brighton Health Commercial |
$9.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.84
|
| Rate for Payer: Group Health Inc Commercial |
$6.50
|
| Rate for Payer: Group Health Inc Medicare |
$4.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$8.45
|
|
