|
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
|
|
|
Uterine & adnexa procedures for ovarian & adnexal malignancy
|
Facility
|
IP
|
$54,544.46
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$13,930.00 |
| Max. Negotiated Rate |
$54,544.46 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$54,544.46
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54,544.46
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,241.98
|
| Rate for Payer: Amida Care Medicaid |
$24,241.98
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$54,544.46
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,241.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,241.98
|
| Rate for Payer: Fidelis Qualified Health Plan |
$29,090.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,241.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,241.98
|
| Rate for Payer: Healthfirst Commercial |
$23,918.00
|
| Rate for Payer: Healthfirst Essential Plan |
$54,544.46
|
| Rate for Payer: Healthfirst QHP |
$13,930.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,241.98
|
| Rate for Payer: SOMOS Essential |
$54,544.46
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$54,544.46
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$54,544.46
|
| Rate for Payer: United Healthcare Medicaid |
$24,241.98
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,241.98
|
|
|
Uterine & adnexa procedures for ovarian & adnexal malignancy
|
Facility
|
IP
|
$76,935.04
|
|
|
Service Code
|
APR-DRG 5113
|
| Min. Negotiated Rate |
$29,444.00 |
| Max. Negotiated Rate |
$76,935.04 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$76,935.04
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$76,935.04
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34,193.35
|
| Rate for Payer: Amida Care Medicaid |
$34,193.35
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$76,935.04
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$34,193.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34,193.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41,032.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,193.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34,193.35
|
| Rate for Payer: Healthfirst Commercial |
$47,970.00
|
| Rate for Payer: Healthfirst Essential Plan |
$76,935.04
|
| Rate for Payer: Healthfirst QHP |
$29,444.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34,193.35
|
| Rate for Payer: SOMOS Essential |
$76,935.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$76,935.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$76,935.04
|
| Rate for Payer: United Healthcare Medicaid |
$34,193.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34,193.35
|
|
|
VACCINE ADMINISTRATION
|
Facility
|
OP
|
$26.36
|
|
|
Service Code
|
EAPG 00459
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$26.36 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18.51
|
| Rate for Payer: Healthfirst Commercial |
$26.36
|
|
|
Vaginal delivery
|
Facility
|
IP
|
$44,792.19
|
|
|
Service Code
|
APR-DRG 5603
|
| Min. Negotiated Rate |
$7,460.00 |
| Max. Negotiated Rate |
$44,792.19 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$44,792.19
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44,792.19
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,907.64
|
| Rate for Payer: Amida Care Medicaid |
$19,907.64
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$44,792.19
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,907.64
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,907.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,889.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,907.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,907.64
|
| Rate for Payer: Healthfirst Commercial |
$12,737.00
|
| Rate for Payer: Healthfirst Essential Plan |
$44,792.19
|
| Rate for Payer: Healthfirst QHP |
$7,460.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,907.64
|
| Rate for Payer: SOMOS Essential |
$44,792.19
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$44,792.19
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44,792.19
|
| Rate for Payer: United Healthcare Medicaid |
$19,907.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,907.64
|
|
|
Vaginal delivery
|
Facility
|
IP
|
$42,308.84
|
|
|
Service Code
|
APR-DRG 5602
|
| Min. Negotiated Rate |
$6,015.00 |
| Max. Negotiated Rate |
$42,308.84 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,308.84
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,308.84
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,803.93
|
| Rate for Payer: Amida Care Medicaid |
$18,803.93
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,308.84
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,803.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,803.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,564.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,803.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,803.93
|
| Rate for Payer: Healthfirst Commercial |
$10,525.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,308.84
|
| Rate for Payer: Healthfirst QHP |
$6,015.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,803.93
|
| Rate for Payer: SOMOS Essential |
$42,308.84
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,308.84
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,308.84
|
| Rate for Payer: United Healthcare Medicaid |
$18,803.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,803.93
|
|
|
Vaginal delivery
|
Facility
|
IP
|
$41,329.24
|
|
|
Service Code
|
APR-DRG 5601
|
| Min. Negotiated Rate |
$5,615.00 |
| Max. Negotiated Rate |
$41,329.24 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,329.24
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,329.24
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,368.55
|
| Rate for Payer: Amida Care Medicaid |
$18,368.55
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,329.24
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,368.55
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,368.55
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,042.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,368.55
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,368.55
|
| Rate for Payer: Healthfirst Commercial |
$9,868.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,329.24
|
| Rate for Payer: Healthfirst QHP |
$5,615.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,368.55
|
| Rate for Payer: SOMOS Essential |
$41,329.24
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,329.24
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,329.24
|
| Rate for Payer: United Healthcare Medicaid |
$18,368.55
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,368.55
|
|
|
Vaginal delivery
|
Facility
|
IP
|
$61,855.56
|
|
|
Service Code
|
APR-DRG 5604
|
| Min. Negotiated Rate |
$12,582.00 |
| Max. Negotiated Rate |
$61,855.56 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$61,855.56
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$61,855.56
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,491.36
|
| Rate for Payer: Amida Care Medicaid |
$27,491.36
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$61,855.56
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,491.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,491.36
|
| Rate for Payer: Fidelis Qualified Health Plan |
$32,989.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,491.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,491.36
|
| Rate for Payer: Healthfirst Commercial |
$27,288.00
|
| Rate for Payer: Healthfirst Essential Plan |
$61,855.56
|
| Rate for Payer: Healthfirst QHP |
$12,582.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,491.36
|
| Rate for Payer: SOMOS Essential |
$61,855.56
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$61,855.56
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61,855.56
|
| Rate for Payer: United Healthcare Medicaid |
$27,491.36
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,491.36
|
|
|
VAGINAL DELIVERY PROCEDURES
|
Facility
|
OP
|
$3,477.95
|
|
|
Service Code
|
EAPG 00195
|
| Min. Negotiated Rate |
$2,524.90 |
| Max. Negotiated Rate |
$3,477.95 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2,524.90
|
| Rate for Payer: Healthfirst Commercial |
$3,477.95
|
|
|
Vaginal delivery w complicating procedures exc sterilization &/or D&C
|
Facility
|
IP
|
$53,501.51
|
|
|
Service Code
|
APR-DRG 5423
|
| Min. Negotiated Rate |
$11,551.00 |
| Max. Negotiated Rate |
$53,501.51 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$53,501.51
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$53,501.51
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$23,778.45
|
| Rate for Payer: Amida Care Medicaid |
$23,778.45
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$53,501.51
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$23,778.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$23,778.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,534.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23,778.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$23,778.45
|
| Rate for Payer: Healthfirst Commercial |
$22,130.00
|
| Rate for Payer: Healthfirst Essential Plan |
$53,501.51
|
| Rate for Payer: Healthfirst QHP |
$11,551.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$23,778.45
|
| Rate for Payer: SOMOS Essential |
$53,501.51
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$53,501.51
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$53,501.51
|
| Rate for Payer: United Healthcare Medicaid |
$23,778.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23,778.45
|
|
|
Vaginal delivery w complicating procedures exc sterilization &/or D&C
|
Facility
|
IP
|
$42,482.97
|
|
|
Service Code
|
APR-DRG 5421
|
| Min. Negotiated Rate |
$5,612.00 |
| Max. Negotiated Rate |
$42,482.97 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,482.97
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,482.97
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,881.32
|
| Rate for Payer: Amida Care Medicaid |
$18,881.32
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,482.97
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,881.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,881.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,657.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,881.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,881.32
|
| Rate for Payer: Healthfirst Commercial |
$10,244.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,482.97
|
| Rate for Payer: Healthfirst QHP |
$5,612.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,881.32
|
| Rate for Payer: SOMOS Essential |
$42,482.97
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,482.97
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,482.97
|
| Rate for Payer: United Healthcare Medicaid |
$18,881.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,881.32
|
|
|
Vaginal delivery w complicating procedures exc sterilization &/or D&C
|
Facility
|
IP
|
$43,944.48
|
|
|
Service Code
|
APR-DRG 5422
|
| Min. Negotiated Rate |
$6,392.00 |
| Max. Negotiated Rate |
$43,944.48 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,944.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,944.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,530.88
|
| Rate for Payer: Amida Care Medicaid |
$19,530.88
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$43,944.48
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,530.88
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,530.88
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,437.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,530.88
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,530.88
|
| Rate for Payer: Healthfirst Commercial |
$11,573.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,944.48
|
| Rate for Payer: Healthfirst QHP |
$6,392.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,530.88
|
| Rate for Payer: SOMOS Essential |
$43,944.48
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,944.48
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,944.48
|
| Rate for Payer: United Healthcare Medicaid |
$19,530.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,530.88
|
|
|
Vaginal delivery w complicating procedures exc sterilization &/or D&C
|
Facility
|
IP
|
$59,117.20
|
|
|
Service Code
|
APR-DRG 5424
|
| Min. Negotiated Rate |
$13,125.00 |
| Max. Negotiated Rate |
$59,117.20 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$59,117.20
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$59,117.20
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$26,274.31
|
| Rate for Payer: Amida Care Medicaid |
$26,274.31
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$59,117.20
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$26,274.31
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$26,274.31
|
| Rate for Payer: Fidelis Qualified Health Plan |
$31,529.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$26,274.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$26,274.31
|
| Rate for Payer: Healthfirst Commercial |
$27,308.00
|
| Rate for Payer: Healthfirst Essential Plan |
$59,117.20
|
| Rate for Payer: Healthfirst QHP |
$13,125.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$26,274.31
|
| Rate for Payer: SOMOS Essential |
$59,117.20
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$59,117.20
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$59,117.20
|
| Rate for Payer: United Healthcare Medicaid |
$26,274.31
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$26,274.31
|
|
|
Vaginal delivery w sterilization &/or D&C
|
Facility
|
IP
|
$51,202.82
|
|
|
Service Code
|
APR-DRG 5414
|
| Min. Negotiated Rate |
$11,247.00 |
| Max. Negotiated Rate |
$51,202.82 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,202.82
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,202.82
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,756.81
|
| Rate for Payer: Amida Care Medicaid |
$22,756.81
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,202.82
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,756.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,756.81
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,308.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,756.81
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,756.81
|
| Rate for Payer: Healthfirst Commercial |
$19,693.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,202.82
|
| Rate for Payer: Healthfirst QHP |
$11,247.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,756.81
|
| Rate for Payer: SOMOS Essential |
$51,202.82
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,202.82
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,202.82
|
| Rate for Payer: United Healthcare Medicaid |
$22,756.81
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,756.81
|
|
|
Vaginal delivery w sterilization &/or D&C
|
Facility
|
IP
|
$45,384.91
|
|
|
Service Code
|
APR-DRG 5412
|
| Min. Negotiated Rate |
$7,937.00 |
| Max. Negotiated Rate |
$45,384.91 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,384.91
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,384.91
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,171.07
|
| Rate for Payer: Amida Care Medicaid |
$20,171.07
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,384.91
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,171.07
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,171.07
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,205.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,171.07
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,171.07
|
| Rate for Payer: Healthfirst Commercial |
$13,432.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,384.91
|
| Rate for Payer: Healthfirst QHP |
$7,937.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,171.07
|
| Rate for Payer: SOMOS Essential |
$45,384.91
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,384.91
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,384.91
|
| Rate for Payer: United Healthcare Medicaid |
$20,171.07
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,171.07
|
|
|
Vaginal delivery w sterilization &/or D&C
|
Facility
|
IP
|
$44,382.42
|
|
|
Service Code
|
APR-DRG 5411
|
| Min. Negotiated Rate |
$7,371.00 |
| Max. Negotiated Rate |
$44,382.42 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$44,382.42
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44,382.42
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,725.52
|
| Rate for Payer: Amida Care Medicaid |
$19,725.52
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$44,382.42
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,725.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,725.52
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,670.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,725.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,725.52
|
| Rate for Payer: Healthfirst Commercial |
$12,824.00
|
| Rate for Payer: Healthfirst Essential Plan |
$44,382.42
|
| Rate for Payer: Healthfirst QHP |
$7,371.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,725.52
|
| Rate for Payer: SOMOS Essential |
$44,382.42
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$44,382.42
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44,382.42
|
| Rate for Payer: United Healthcare Medicaid |
$19,725.52
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,725.52
|
|
|
Vaginal delivery w sterilization &/or D&C
|
Facility
|
IP
|
$49,530.26
|
|
|
Service Code
|
APR-DRG 5413
|
| Min. Negotiated Rate |
$10,273.00 |
| Max. Negotiated Rate |
$49,530.26 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$49,530.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$49,530.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,013.45
|
| Rate for Payer: Amida Care Medicaid |
$22,013.45
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$49,530.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,013.45
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,013.45
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,416.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,013.45
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,013.45
|
| Rate for Payer: Healthfirst Commercial |
$17,717.00
|
| Rate for Payer: Healthfirst Essential Plan |
$49,530.26
|
| Rate for Payer: Healthfirst QHP |
$10,273.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,013.45
|
| Rate for Payer: SOMOS Essential |
$49,530.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$49,530.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$49,530.26
|
| Rate for Payer: United Healthcare Medicaid |
$22,013.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,013.45
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
IP
|
$7.07
|
|
|
Service Code
|
NDC 6586244890
|
| Hospital Charge Code |
6586244890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
OP
|
$7.07
|
|
|
Service Code
|
NDC 6586244830
|
| Hospital Charge Code |
6586244830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$5.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.54
|
| Rate for Payer: Aetna Government |
$3.54
|
| Rate for Payer: Brighton Health Commercial |
$5.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.81
|
| Rate for Payer: EmblemHealth Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Commercial |
$3.54
|
| Rate for Payer: Group Health Inc Medicare |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.60
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
OP
|
$7.22
|
|
|
Service Code
|
NDC 5107909303
|
| Hospital Charge Code |
5107909303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.61
|
| Rate for Payer: Aetna Government |
$3.61
|
| Rate for Payer: Brighton Health Commercial |
$5.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.91
|
| Rate for Payer: EmblemHealth Commercial |
$3.61
|
| Rate for Payer: Group Health Inc Commercial |
$3.61
|
| Rate for Payer: Group Health Inc Medicare |
$2.53
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.70
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
IP
|
$7.22
|
|
|
Service Code
|
NDC 5723704230
|
| Hospital Charge Code |
5723704230
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 0904656561
|
| Hospital Charge Code |
0904656561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 0904656561
|
| Hospital Charge Code |
0904656561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.19
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.99
|
| Rate for Payer: EmblemHealth Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.90
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
IP
|
$7.22
|
|
|
Service Code
|
NDC 5107909303
|
| Hospital Charge Code |
5107909303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$3.61 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.61
|
|
|
VALACYCLOVIR HCL 500 MG PO TABS
|
Facility
|
IP
|
$7.07
|
|
|
Service Code
|
NDC 6586244830
|
| Hospital Charge Code |
6586244830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.54
|
|
