|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$30,420.98
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$9,149.53 |
| Max. Negotiated Rate |
$30,420.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,732.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,124.35
|
| Rate for Payer: Aetna Government |
$22,124.35
|
| Rate for Payer: Brighton Health Commercial |
$15,471.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,566.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,426.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,205.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,018.13
|
| Rate for Payer: EmblemHealth Commercial |
$9,149.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,124.35
|
| Rate for Payer: Group Health Inc Commercial |
$22,124.35
|
| Rate for Payer: Group Health Inc Medicare |
$22,124.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,124.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,287.82
|
| Rate for Payer: Humana Medicare |
$30,420.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,124.35
|
| Rate for Payer: United Healthcare Commercial |
$21,219.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,124.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,124.35
|
| Rate for Payer: Wellcare Medicare |
$21,018.13
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$40,130.21
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$13,515.90 |
| Max. Negotiated Rate |
$40,130.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,241.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,185.61
|
| Rate for Payer: Aetna Government |
$29,185.61
|
| Rate for Payer: Brighton Health Commercial |
$22,854.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,769.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,219.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,462.62
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,726.33
|
| Rate for Payer: EmblemHealth Commercial |
$13,515.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,185.61
|
| Rate for Payer: Group Health Inc Commercial |
$29,185.61
|
| Rate for Payer: Group Health Inc Medicare |
$29,185.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,185.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,571.31
|
| Rate for Payer: Humana Medicare |
$40,130.21
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,185.61
|
| Rate for Payer: United Healthcare Commercial |
$31,345.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,185.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,185.61
|
| Rate for Payer: Wellcare Medicare |
$27,726.33
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,609.99
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$6,086.54 |
| Max. Negotiated Rate |
$23,609.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10,466.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17,170.90
|
| Rate for Payer: Aetna Government |
$17,170.90
|
| Rate for Payer: Brighton Health Commercial |
$10,292.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17,514.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12,257.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10,115.44
|
| Rate for Payer: Elderplan Medicare Advantage |
$16,312.36
|
| Rate for Payer: EmblemHealth Commercial |
$6,086.54
|
| Rate for Payer: Fidelis Medicare Advantage |
$17,170.90
|
| Rate for Payer: Group Health Inc Commercial |
$17,170.90
|
| Rate for Payer: Group Health Inc Medicare |
$17,170.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17,170.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,984.47
|
| Rate for Payer: Humana Medicare |
$23,609.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17,170.90
|
| Rate for Payer: United Healthcare Commercial |
$14,115.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,170.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17,170.90
|
| Rate for Payer: Wellcare Medicare |
$16,312.36
|
|
|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$50,218.92
|
|
|
Service Code
|
MSDRG 336
|
| Min. Negotiated Rate |
$16,983.13 |
| Max. Negotiated Rate |
$50,218.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31,042.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$36,522.85
|
| Rate for Payer: Aetna Government |
$36,522.85
|
| Rate for Payer: Brighton Health Commercial |
$30,526.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$37,253.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36,356.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30,002.88
|
| Rate for Payer: Elderplan Medicare Advantage |
$34,696.71
|
| Rate for Payer: EmblemHealth Commercial |
$18,052.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$36,522.85
|
| Rate for Payer: Group Health Inc Commercial |
$36,522.85
|
| Rate for Payer: Group Health Inc Medicare |
$36,522.85
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$36,522.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,983.13
|
| Rate for Payer: Humana Medicare |
$50,218.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$36,522.85
|
| Rate for Payer: United Healthcare Commercial |
$41,868.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,522.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36,522.85
|
| Rate for Payer: Wellcare Medicare |
$34,696.71
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$78,242.63
|
|
|
Service Code
|
MSDRG 335
|
| Min. Negotiated Rate |
$26,460.23 |
| Max. Negotiated Rate |
$78,242.63 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$52,713.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$56,903.73
|
| Rate for Payer: Aetna Government |
$56,903.73
|
| Rate for Payer: Brighton Health Commercial |
$51,837.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58,041.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$61,736.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$50,947.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$54,058.54
|
| Rate for Payer: EmblemHealth Commercial |
$30,655.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$56,903.73
|
| Rate for Payer: Group Health Inc Commercial |
$56,903.73
|
| Rate for Payer: Group Health Inc Medicare |
$56,903.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56,903.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,460.23
|
| Rate for Payer: Humana Medicare |
$78,242.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$56,903.73
|
| Rate for Payer: United Healthcare Commercial |
$71,096.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56,903.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56,903.73
|
| Rate for Payer: Wellcare Medicare |
$54,058.54
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$38,608.62
|
|
|
Service Code
|
MSDRG 337
|
| Min. Negotiated Rate |
$12,831.60 |
| Max. Negotiated Rate |
$38,608.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,064.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,079.00
|
| Rate for Payer: Aetna Government |
$28,079.00
|
| Rate for Payer: Brighton Health Commercial |
$21,697.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,640.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,841.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,325.38
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,675.05
|
| Rate for Payer: EmblemHealth Commercial |
$12,831.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,079.00
|
| Rate for Payer: Group Health Inc Commercial |
$28,079.00
|
| Rate for Payer: Group Health Inc Medicare |
$28,079.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,079.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,056.74
|
| Rate for Payer: Humana Medicare |
$38,608.62
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,079.00
|
| Rate for Payer: United Healthcare Commercial |
$29,758.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,079.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,079.00
|
| Rate for Payer: Wellcare Medicare |
$26,675.05
|
|
|
PERITONEAL ADMINISTRATION SET
|
Facility
|
OP
|
$21.26
|
|
| Hospital Charge Code |
40204830
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.63
|
| Rate for Payer: Aetna Government |
$10.63
|
| Rate for Payer: Brighton Health Commercial |
$15.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.46
|
| Rate for Payer: Group Health Inc Commercial |
$10.63
|
| Rate for Payer: Group Health Inc Medicare |
$7.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.63
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.63
|
|
|
PERITONEAL DIALY. CATH.
|
Facility
|
OP
|
$19.85
|
|
| Hospital Charge Code |
40509814
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.92
|
| Rate for Payer: Aetna Government |
$9.92
|
| Rate for Payer: Brighton Health Commercial |
$14.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.50
|
| Rate for Payer: Group Health Inc Commercial |
$9.92
|
| Rate for Payer: Group Health Inc Medicare |
$6.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.92
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
PERITONEAL DIALY.DRAIN.BAG
|
Facility
|
OP
|
$10.64
|
|
| Hospital Charge Code |
40509820
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.32
|
| Rate for Payer: Aetna Government |
$5.32
|
| Rate for Payer: Brighton Health Commercial |
$7.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.24
|
| Rate for Payer: Group Health Inc Commercial |
$5.32
|
| Rate for Payer: Group Health Inc Medicare |
$3.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.32
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
PERITONEAL DIALYSIS SET
|
Facility
|
OP
|
$11.34
|
|
| Hospital Charge Code |
40509800
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.67
|
| Rate for Payer: Aetna Government |
$5.67
|
| Rate for Payer: Brighton Health Commercial |
$8.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.71
|
| Rate for Payer: Group Health Inc Commercial |
$5.67
|
| Rate for Payer: Group Health Inc Medicare |
$3.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.67
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
|
|
PERITONEAL DIALYSIS UNIT
|
Facility
|
OP
|
$27.29
|
|
| Hospital Charge Code |
40204831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$13.64
|
| Rate for Payer: Aetna Government |
$13.64
|
| Rate for Payer: Brighton Health Commercial |
$20.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.83
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.56
|
| Rate for Payer: Group Health Inc Commercial |
$13.64
|
| Rate for Payer: Group Health Inc Medicare |
$9.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.64
|
|
|
PERITONEAL LAVAGE
|
Facility
|
IP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
40019509
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$1,048.28
|
|
|
PERITONEAL LAVAGE
|
Facility
|
OP
|
$2,380.35
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
40019509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,048.28
|
| Rate for Payer: Aetna Government |
$1,048.28
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$733.80
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$733.80
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$733.80
|
| Rate for Payer: Brighton Health Commercial |
$1,785.26
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Cash Price |
$1,048.28
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,048.28
|
| 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 |
$1,048.28
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$891.04
|
| Rate for Payer: Fidelis Essential Plan QHP |
$932.97
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,048.28
|
| Rate for Payer: Fidelis Qualified Health Plan |
$932.97
|
| Rate for Payer: Group Health Inc Commercial |
$1,048.28
|
| Rate for Payer: Group Health Inc Medicare |
$1,048.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,190.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,048.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$891.04
|
| Rate for Payer: Healthfirst QHP |
$1,048.28
|
| Rate for Payer: Humana Medicare |
$1,069.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,048.28
|
| Rate for Payer: United Healthcare Commercial |
$1,409.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,048.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,048.28
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$838.62
|
| Rate for Payer: Wellcare Medicare |
$995.87
|
|
|
PERITONEAL LAVAGE KIT
|
Facility
|
OP
|
$85.76
|
|
| Hospital Charge Code |
40207631
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$68.61 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$42.88
|
| Rate for Payer: Aetna Government |
$42.88
|
| Rate for Payer: Brighton Health Commercial |
$64.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$68.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$58.32
|
| Rate for Payer: Group Health Inc Commercial |
$42.88
|
| Rate for Payer: Group Health Inc Medicare |
$30.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$42.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$42.88
|
|
|
PER KNEE SYS ART SUR RT 12MM
|
Facility
|
IP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.00 |
| Max. Negotiated Rate |
$1,700.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
|
|
PER KNEE SYS ART SUR RT 12MM
|
Facility
|
OP
|
$3,400.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40203389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,570.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,870.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Brighton Health Commercial |
$2,040.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,700.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,955.00
|
| Rate for Payer: EmblemHealth Commercial |
$1,700.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,570.00
|
| Rate for Payer: Group Health Inc Commercial |
$1,700.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,190.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,700.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,700.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,210.00
|
|
|
PERMA CATHETER
|
Facility
|
OP
|
$886.29
|
|
| Hospital Charge Code |
40207006
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$310.20 |
| Max. Negotiated Rate |
$709.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$487.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$443.14
|
| Rate for Payer: Aetna Government |
$443.14
|
| Rate for Payer: Brighton Health Commercial |
$664.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$709.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$602.68
|
| Rate for Payer: Group Health Inc Commercial |
$443.14
|
| Rate for Payer: Group Health Inc Medicare |
$310.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$443.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$443.14
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$53,504.28
|
|
|
Service Code
|
MSDRG 243
|
| Min. Negotiated Rate |
$18,094.17 |
| Max. Negotiated Rate |
$53,504.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,583.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,912.20
|
| Rate for Payer: Aetna Government |
$38,912.20
|
| Rate for Payer: Brighton Health Commercial |
$33,025.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,690.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39,331.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,458.35
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,966.59
|
| Rate for Payer: EmblemHealth Commercial |
$19,530.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,912.20
|
| Rate for Payer: Group Health Inc Commercial |
$38,912.20
|
| Rate for Payer: Group Health Inc Medicare |
$38,912.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,912.20
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,094.17
|
| Rate for Payer: Humana Medicare |
$53,504.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,912.20
|
| Rate for Payer: United Healthcare Commercial |
$45,294.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,912.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,912.20
|
| Rate for Payer: Wellcare Medicare |
$36,966.59
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$75,956.42
|
|
|
Service Code
|
MSDRG 242
|
| Min. Negotiated Rate |
$25,687.08 |
| Max. Negotiated Rate |
$75,956.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$50,945.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$55,241.03
|
| Rate for Payer: Aetna Government |
$55,241.03
|
| Rate for Payer: Brighton Health Commercial |
$50,098.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$56,345.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$59,666.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49,239.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$52,478.98
|
| Rate for Payer: EmblemHealth Commercial |
$29,627.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$55,241.03
|
| Rate for Payer: Group Health Inc Commercial |
$55,241.03
|
| Rate for Payer: Group Health Inc Medicare |
$55,241.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$55,241.03
|
| Rate for Payer: Healthfirst Medicare Advantage |
$25,687.08
|
| Rate for Payer: Humana Medicare |
$75,956.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$55,241.03
|
| Rate for Payer: United Healthcare Commercial |
$68,711.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55,241.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$55,241.03
|
| Rate for Payer: Wellcare Medicare |
$52,478.98
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$44,960.04
|
|
|
Service Code
|
MSDRG 244
|
| Min. Negotiated Rate |
$15,204.67 |
| Max. Negotiated Rate |
$44,960.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26,975.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$32,698.21
|
| Rate for Payer: Aetna Government |
$32,698.21
|
| Rate for Payer: Brighton Health Commercial |
$26,527.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$33,352.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$31,593.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$26,072.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$31,063.30
|
| Rate for Payer: EmblemHealth Commercial |
$15,688.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$32,698.21
|
| Rate for Payer: Group Health Inc Commercial |
$32,698.21
|
| Rate for Payer: Group Health Inc Medicare |
$32,698.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$32,698.21
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,204.67
|
| Rate for Payer: Humana Medicare |
$44,960.04
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$32,698.21
|
| Rate for Payer: United Healthcare Commercial |
$36,383.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,698.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$32,698.21
|
| Rate for Payer: Wellcare Medicare |
$31,063.30
|
|
|
PERMETHRIN 1% LOTION
|
Facility
|
OP
|
$8.63
|
|
| Hospital Charge Code |
41643577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.32
|
| Rate for Payer: Aetna Government |
$4.32
|
| Rate for Payer: Brighton Health Commercial |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.32
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.61
|
|
|
PERMETHRIN 1% LOTION
|
Facility
|
OP
|
$8.63
|
|
| Hospital Charge Code |
41653577
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.32
|
| Rate for Payer: Aetna Government |
$4.32
|
| Rate for Payer: Brighton Health Commercial |
$6.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.87
|
| Rate for Payer: Group Health Inc Commercial |
$4.32
|
| Rate for Payer: Group Health Inc Medicare |
$3.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.61
|
|
|
PERMETHRIN 5% CREAM
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
41640076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.00
|
| Rate for Payer: Aetna Government |
$45.00
|
| Rate for Payer: Brighton Health Commercial |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.20
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
PERMETHRIN 5% CREAM
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
41650076
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$45.00
|
| Rate for Payer: Aetna Government |
$45.00
|
| Rate for Payer: Brighton Health Commercial |
$67.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.20
|
| Rate for Payer: Group Health Inc Commercial |
$45.00
|
| Rate for Payer: Group Health Inc Medicare |
$31.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.50
|
|
|
PERMETHRIN 5 % EX CREA [10917]
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 45802026937
|
| Hospital Charge Code |
45802026937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.99
|
| Rate for Payer: Aetna Government |
$0.99
|
| Rate for Payer: Brighton Health Commercial |
$1.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.99
|
| Rate for Payer: Group Health Inc Medicare |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.99
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.29
|
|
