|
URSODIOL 300 MG PO CAPS
|
Facility
|
OP
|
$7.64
|
|
|
Service Code
|
NDC 6068710001
|
| Hospital Charge Code |
6068710001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Brighton Health Commercial |
$5.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.20
|
| Rate for Payer: EmblemHealth Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.97
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
OP
|
$8.98
|
|
|
Service Code
|
NDC 0904622106
|
| Hospital Charge Code |
0904622106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$7.19 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.94
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.49
|
| Rate for Payer: Aetna Government |
$4.49
|
| Rate for Payer: Brighton Health Commercial |
$6.74
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.19
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.11
|
| Rate for Payer: EmblemHealth Commercial |
$4.49
|
| Rate for Payer: Group Health Inc Commercial |
$4.49
|
| Rate for Payer: Group Health Inc Medicare |
$3.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.84
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
IP
|
$8.98
|
|
|
Service Code
|
NDC 0904622106
|
| Hospital Charge Code |
0904622106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.49
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
IP
|
$7.64
|
|
|
Service Code
|
NDC 6068710001
|
| Hospital Charge Code |
6068710001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
OP
|
$5.27
|
|
|
Service Code
|
NDC 0904622161
|
| Hospital Charge Code |
0904622161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.64
|
| Rate for Payer: Aetna Government |
$2.64
|
| Rate for Payer: Brighton Health Commercial |
$3.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.58
|
| Rate for Payer: EmblemHealth Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Commercial |
$2.64
|
| Rate for Payer: Group Health Inc Medicare |
$1.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.43
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
IP
|
$5.27
|
|
|
Service Code
|
NDC 0904622161
|
| Hospital Charge Code |
0904622161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.64
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
OP
|
$7.64
|
|
|
Service Code
|
NDC 6068710011
|
| Hospital Charge Code |
6068710011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$6.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Brighton Health Commercial |
$5.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.20
|
| Rate for Payer: EmblemHealth Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.97
|
|
|
URSODIOL 300 MG PO CAPS
|
Facility
|
IP
|
$7.35
|
|
|
Service Code
|
NDC 6923815401
|
| Hospital Charge Code |
6923815401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.68
|
|
|
URSODIOL 60 MG/ML PO SUSP (SBH)
|
Facility
|
IP
|
$2.50
|
|
|
Service Code
|
NDC 9999701482
|
| Hospital Charge Code |
9999701482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
|
|
URSODIOL 60 MG/ML PO SUSP (SBH)
|
Facility
|
OP
|
$2.50
|
|
|
Service Code
|
NDC 9999701482
|
| Hospital Charge Code |
9999701482
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.25
|
| Rate for Payer: Aetna Government |
$1.25
|
| Rate for Payer: Brighton Health Commercial |
$1.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.70
|
| Rate for Payer: EmblemHealth Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Commercial |
$1.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.62
|
|
|
USTEKINUMAB 130 MG/26ML IV SOLN
|
Facility
|
OP
|
$93.44
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
5789405427
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$51.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.99
|
| Rate for Payer: Aetna Government |
$12.99
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$9.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$9.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$9.09
|
| Rate for Payer: Brighton Health Commercial |
$70.08
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$12.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$74.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$63.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$12.99
|
| Rate for Payer: EmblemHealth Commercial |
$12.99
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$11.69
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$11.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$11.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$12.99
|
| Rate for Payer: Fidelis Qualified Health Plan |
$11.56
|
| Rate for Payer: Group Health Inc Commercial |
$12.99
|
| Rate for Payer: Group Health Inc Medicare |
$12.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.99
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$12.99
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.04
|
| Rate for Payer: Healthfirst QHP |
$12.99
|
| Rate for Payer: Humana Medicare |
$13.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$12.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$60.74
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$12.34
|
| Rate for Payer: Wellcare Medicare |
$12.34
|
|
|
USTEKINUMAB 130 MG/26ML IV SOLN
|
Facility
|
IP
|
$93.44
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
5789405427
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$46.72 |
| Max. Negotiated Rate |
$46.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$46.72
|
|
|
Uterine & adnexa procedures for leiomyoma
|
Facility
|
IP
|
$50,924.95
|
|
|
Service Code
|
APR-DRG 5192
|
| Min. Negotiated Rate |
$10,454.00 |
| Max. Negotiated Rate |
$50,924.95 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,924.95
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,924.95
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,633.31
|
| Rate for Payer: Amida Care Medicaid |
$22,633.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,924.95
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,633.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,633.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,159.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,633.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,633.31
|
| Rate for Payer: Healthfirst Commercial |
$18,380.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,924.95
|
| Rate for Payer: Healthfirst QHP |
$10,454.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,633.31
|
| Rate for Payer: SOMOS Essential |
$50,924.95
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,924.95
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,924.95
|
| Rate for Payer: United Healthcare Medicaid |
$22,633.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,633.31
|
|
|
Uterine & adnexa procedures for leiomyoma
|
Facility
|
IP
|
$138,399.70
|
|
|
Service Code
|
APR-DRG 5194
|
| Min. Negotiated Rate |
$41,268.00 |
| Max. Negotiated Rate |
$138,399.70 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$138,399.70
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$138,399.70
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$61,510.98
|
| Rate for Payer: Amida Care Medicaid |
$61,510.98
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$138,399.70
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$61,510.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$61,510.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$73,813.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$61,510.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$61,510.98
|
| Rate for Payer: Healthfirst Commercial |
$63,408.00
|
| Rate for Payer: Healthfirst Essential Plan |
$138,399.70
|
| Rate for Payer: Healthfirst QHP |
$41,268.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$61,510.98
|
| Rate for Payer: SOMOS Essential |
$138,399.70
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$138,399.70
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$138,399.70
|
| Rate for Payer: United Healthcare Medicaid |
$61,510.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$61,510.98
|
|
|
Uterine & adnexa procedures for leiomyoma
|
Facility
|
IP
|
$47,120.78
|
|
|
Service Code
|
APR-DRG 5191
|
| Min. Negotiated Rate |
$8,858.00 |
| Max. Negotiated Rate |
$47,120.78 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$47,120.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47,120.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,942.57
|
| Rate for Payer: Amida Care Medicaid |
$20,942.57
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$47,120.78
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,942.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,942.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,131.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,942.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,942.57
|
| Rate for Payer: Healthfirst Commercial |
$15,315.00
|
| Rate for Payer: Healthfirst Essential Plan |
$47,120.78
|
| Rate for Payer: Healthfirst QHP |
$8,858.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,942.57
|
| Rate for Payer: SOMOS Essential |
$47,120.78
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47,120.78
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$47,120.78
|
| Rate for Payer: United Healthcare Medicaid |
$20,942.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,942.57
|
|
|
Uterine & adnexa procedures for leiomyoma
|
Facility
|
IP
|
$66,827.54
|
|
|
Service Code
|
APR-DRG 5193
|
| Min. Negotiated Rate |
$19,090.00 |
| Max. Negotiated Rate |
$66,827.54 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$66,827.54
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$66,827.54
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$29,701.13
|
| Rate for Payer: Amida Care Medicaid |
$29,701.13
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$66,827.54
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$29,701.13
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$29,701.13
|
| Rate for Payer: Fidelis Qualified Health Plan |
$35,641.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$29,701.13
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$29,701.13
|
| Rate for Payer: Healthfirst Commercial |
$36,234.00
|
| Rate for Payer: Healthfirst Essential Plan |
$66,827.54
|
| Rate for Payer: Healthfirst QHP |
$19,090.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$29,701.13
|
| Rate for Payer: SOMOS Essential |
$66,827.54
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$66,827.54
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$66,827.54
|
| Rate for Payer: United Healthcare Medicaid |
$29,701.13
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$29,701.13
|
|
|
Uterine & adnexa procedures for non-malignancy except leiomyoma
|
Facility
|
IP
|
$64,557.00
|
|
|
Service Code
|
APR-DRG 5133
|
| Min. Negotiated Rate |
$16,846.00 |
| Max. Negotiated Rate |
$64,557.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$64,557.00
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$64,557.00
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$28,692.00
|
| Rate for Payer: Amida Care Medicaid |
$28,692.00
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$64,557.00
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$28,692.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$28,692.00
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34,430.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28,692.00
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$28,692.00
|
| Rate for Payer: Healthfirst Commercial |
$30,255.00
|
| Rate for Payer: Healthfirst Essential Plan |
$64,557.00
|
| Rate for Payer: Healthfirst QHP |
$16,846.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$28,692.00
|
| Rate for Payer: SOMOS Essential |
$64,557.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$64,557.00
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$64,557.00
|
| Rate for Payer: United Healthcare Medicaid |
$28,692.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$28,692.00
|
|
|
Uterine & adnexa procedures for non-malignancy except leiomyoma
|
Facility
|
IP
|
$116,464.63
|
|
|
Service Code
|
APR-DRG 5134
|
| Min. Negotiated Rate |
$43,560.00 |
| Max. Negotiated Rate |
$116,464.63 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$116,464.63
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$116,464.63
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$51,762.06
|
| Rate for Payer: Amida Care Medicaid |
$51,762.06
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$116,464.63
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$51,762.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$51,762.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$62,114.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51,762.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$51,762.06
|
| Rate for Payer: Healthfirst Commercial |
$74,651.00
|
| Rate for Payer: Healthfirst Essential Plan |
$116,464.63
|
| Rate for Payer: Healthfirst QHP |
$43,560.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$51,762.06
|
| Rate for Payer: SOMOS Essential |
$116,464.63
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$116,464.63
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$116,464.63
|
| Rate for Payer: United Healthcare Medicaid |
$51,762.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$51,762.06
|
|
|
Uterine & adnexa procedures for non-malignancy except leiomyoma
|
Facility
|
IP
|
$47,365.25
|
|
|
Service Code
|
APR-DRG 5131
|
| Min. Negotiated Rate |
$8,747.00 |
| Max. Negotiated Rate |
$47,365.25 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$47,365.25
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$47,365.25
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,051.22
|
| Rate for Payer: Amida Care Medicaid |
$21,051.22
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$47,365.25
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,051.22
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,051.22
|
| Rate for Payer: Fidelis Qualified Health Plan |
$25,261.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,051.22
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,051.22
|
| Rate for Payer: Healthfirst Commercial |
$15,352.00
|
| Rate for Payer: Healthfirst Essential Plan |
$47,365.25
|
| Rate for Payer: Healthfirst QHP |
$8,747.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,051.22
|
| Rate for Payer: SOMOS Essential |
$47,365.25
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$47,365.25
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$47,365.25
|
| Rate for Payer: United Healthcare Medicaid |
$21,051.22
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,051.22
|
|
|
Uterine & adnexa procedures for non-malignancy except leiomyoma
|
Facility
|
IP
|
$50,275.98
|
|
|
Service Code
|
APR-DRG 5132
|
| Min. Negotiated Rate |
$10,139.00 |
| Max. Negotiated Rate |
$50,275.98 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,275.98
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,275.98
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,344.88
|
| Rate for Payer: Amida Care Medicaid |
$22,344.88
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,275.98
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,344.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,344.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,813.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,344.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,344.88
|
| Rate for Payer: Healthfirst Commercial |
$18,059.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,275.98
|
| Rate for Payer: Healthfirst QHP |
$10,139.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,344.88
|
| Rate for Payer: SOMOS Essential |
$50,275.98
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,275.98
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,275.98
|
| Rate for Payer: United Healthcare Medicaid |
$22,344.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,344.88
|
|
|
Uterine & adnexa procedures for non-ovarian & non-adnexal malig
|
Facility
|
IP
|
$51,276.69
|
|
|
Service Code
|
APR-DRG 5121
|
| Min. Negotiated Rate |
$12,321.00 |
| Max. Negotiated Rate |
$51,276.69 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,276.69
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,276.69
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,789.64
|
| Rate for Payer: Amida Care Medicaid |
$22,789.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,276.69
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,789.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,789.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,347.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,789.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,789.64
|
| Rate for Payer: Healthfirst Commercial |
$21,280.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,276.69
|
| Rate for Payer: Healthfirst QHP |
$12,321.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,789.64
|
| Rate for Payer: SOMOS Essential |
$51,276.69
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,276.69
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,276.69
|
| Rate for Payer: United Healthcare Medicaid |
$22,789.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,789.64
|
|
|
Uterine & adnexa procedures for non-ovarian & non-adnexal malig
|
Facility
|
IP
|
$163,982.43
|
|
|
Service Code
|
APR-DRG 5124
|
| Min. Negotiated Rate |
$59,119.00 |
| Max. Negotiated Rate |
$163,982.43 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$163,982.43
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$163,982.43
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$72,881.08
|
| Rate for Payer: Amida Care Medicaid |
$72,881.08
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$163,982.43
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$72,881.08
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$72,881.08
|
| Rate for Payer: Fidelis Qualified Health Plan |
$87,457.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$72,881.08
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$72,881.08
|
| Rate for Payer: Healthfirst Commercial |
$91,943.00
|
| Rate for Payer: Healthfirst Essential Plan |
$163,982.43
|
| Rate for Payer: Healthfirst QHP |
$59,119.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$72,881.08
|
| Rate for Payer: SOMOS Essential |
$163,982.43
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$163,982.43
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$163,982.43
|
| Rate for Payer: United Healthcare Medicaid |
$72,881.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$72,881.08
|
|
|
Uterine & adnexa procedures for non-ovarian & non-adnexal malig
|
Facility
|
IP
|
$72,548.73
|
|
|
Service Code
|
APR-DRG 5123
|
| Min. Negotiated Rate |
$25,414.00 |
| Max. Negotiated Rate |
$72,548.73 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$72,548.73
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$72,548.73
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32,243.88
|
| Rate for Payer: Amida Care Medicaid |
$32,243.88
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$72,548.73
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32,243.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32,243.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,692.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32,243.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32,243.88
|
| Rate for Payer: Healthfirst Commercial |
$46,386.00
|
| Rate for Payer: Healthfirst Essential Plan |
$72,548.73
|
| Rate for Payer: Healthfirst QHP |
$25,414.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32,243.88
|
| Rate for Payer: SOMOS Essential |
$72,548.73
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$72,548.73
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$72,548.73
|
| Rate for Payer: United Healthcare Medicaid |
$32,243.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32,243.88
|
|
|
Uterine & adnexa procedures for non-ovarian & non-adnexal malig
|
Facility
|
IP
|
$55,875.82
|
|
|
Service Code
|
APR-DRG 5122
|
| Min. Negotiated Rate |
$14,381.00 |
| Max. Negotiated Rate |
$55,875.82 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$55,875.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$55,875.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,833.70
|
| Rate for Payer: Amida Care Medicaid |
$24,833.70
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$55,875.82
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,833.70
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,833.70
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,800.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,833.70
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,833.70
|
| Rate for Payer: Healthfirst Commercial |
$25,899.00
|
| Rate for Payer: Healthfirst Essential Plan |
$55,875.82
|
| Rate for Payer: Healthfirst QHP |
$14,381.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,833.70
|
| Rate for Payer: SOMOS Essential |
$55,875.82
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$55,875.82
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$55,875.82
|
| Rate for Payer: United Healthcare Medicaid |
$24,833.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,833.70
|
|
|
Uterine & adnexa procedures for ovarian & adnexal malignancy
|
Facility
|
IP
|
$59,097.85
|
|
|
Service Code
|
APR-DRG 5112
|
| Min. Negotiated Rate |
$17,390.00 |
| Max. Negotiated Rate |
$59,097.85 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$59,097.85
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59,097.85
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,265.71
|
| Rate for Payer: Amida Care Medicaid |
$26,265.71
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$59,097.85
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,265.71
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,265.71
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,518.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,265.71
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,265.71
|
| Rate for Payer: Healthfirst Commercial |
$29,000.00
|
| Rate for Payer: Healthfirst Essential Plan |
$59,097.85
|
| Rate for Payer: Healthfirst QHP |
$17,390.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,265.71
|
| Rate for Payer: SOMOS Essential |
$59,097.85
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$59,097.85
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$59,097.85
|
| Rate for Payer: United Healthcare Medicaid |
$26,265.71
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,265.71
|
|
