|
BACITRACIN TOPICAL OINTMENT
|
Facility
OP
|
$0.05
|
|
| Hospital Charge Code |
41644311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.03
|
| Rate for Payer: Aetna Government |
$0.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.03
|
| Rate for Payer: Group Health Inc Medicare |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.03
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
BACITRACIN TOP OINT 28.4G TUBE
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41645901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
BACITRACIN TOP OINT 28.4G TUBE
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41655901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
IP
|
$35,319.71
|
|
|
Service Code
|
MS-DRG 519
|
| Min. Negotiated Rate |
$16,101.63 |
| Max. Negotiated Rate |
$35,319.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,027.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,627.17
|
| Rate for Payer: Aetna Government |
$34,627.17
|
| Rate for Payer: Brighton Health Commercial |
$28,544.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,319.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,995.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,054.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,895.81
|
| Rate for Payer: EmblemHealth Commercial |
$16,880.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,627.17
|
| Rate for Payer: Group Health Inc Commercial |
$34,627.17
|
| Rate for Payer: Group Health Inc Medicare |
$34,627.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,627.17
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,101.63
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,627.17
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,627.17
|
| Rate for Payer: Wellcare Medicare |
$32,895.81
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
IP
|
$63,062.93
|
|
|
Service Code
|
MS-DRG 518
|
| Min. Negotiated Rate |
$26,955.48 |
| Max. Negotiated Rate |
$63,062.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53,845.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57,968.77
|
| Rate for Payer: Aetna Government |
$57,968.77
|
| Rate for Payer: Brighton Health Commercial |
$52,951.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$59,128.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$63,062.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$52,042.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$55,070.33
|
| Rate for Payer: EmblemHealth Commercial |
$31,314.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$57,968.77
|
| Rate for Payer: Group Health Inc Commercial |
$57,968.77
|
| Rate for Payer: Group Health Inc Medicare |
$57,968.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57,968.77
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,955.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57,968.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57,968.77
|
| Rate for Payer: Wellcare Medicare |
$55,070.33
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
IP
|
$27,722.59
|
|
|
Service Code
|
MS-DRG 520
|
| Min. Negotiated Rate |
$12,275.10 |
| Max. Negotiated Rate |
$27,722.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,107.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,179.01
|
| Rate for Payer: Aetna Government |
$27,179.01
|
| Rate for Payer: Brighton Health Commercial |
$20,756.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$27,722.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$24,720.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20,400.48
|
| Rate for Payer: Elderplan Medicare Advantage |
$25,820.06
|
| Rate for Payer: EmblemHealth Commercial |
$12,275.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,179.01
|
| Rate for Payer: Group Health Inc Commercial |
$27,179.01
|
| Rate for Payer: Group Health Inc Medicare |
$27,179.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,179.01
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,638.24
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,179.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,179.01
|
| Rate for Payer: Wellcare Medicare |
$25,820.06
|
|
|
BACKBOARD WOOD 72L X 16W
|
Facility
OP
|
$233.98
|
|
| Hospital Charge Code |
64903674
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$187.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$128.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$116.99
|
| Rate for Payer: Aetna Government |
$116.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$187.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$159.11
|
| Rate for Payer: Group Health Inc Commercial |
$116.99
|
| Rate for Payer: Group Health Inc Medicare |
$81.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$116.99
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$116.99
|
|
|
BACK SUP ULTRALIGN TLSO L
|
Facility
OP
|
$755.38
|
|
| Hospital Charge Code |
64903744
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.38 |
| Max. Negotiated Rate |
$604.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$415.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$377.69
|
| Rate for Payer: Aetna Government |
$377.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$604.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$513.66
|
| Rate for Payer: Group Health Inc Commercial |
$377.69
|
| Rate for Payer: Group Health Inc Medicare |
$264.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.69
|
|
|
BACK SUP ULTRALIGN TLSO M
|
Facility
OP
|
$755.38
|
|
| Hospital Charge Code |
64903742
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.38 |
| Max. Negotiated Rate |
$604.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$415.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$377.69
|
| Rate for Payer: Aetna Government |
$377.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$604.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$513.66
|
| Rate for Payer: Group Health Inc Commercial |
$377.69
|
| Rate for Payer: Group Health Inc Medicare |
$264.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.69
|
|
|
BACK SUP ULTRALIGN TLSO S
|
Facility
OP
|
$755.38
|
|
| Hospital Charge Code |
64903740
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.38 |
| Max. Negotiated Rate |
$604.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$415.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$377.69
|
| Rate for Payer: Aetna Government |
$377.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$604.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$513.66
|
| Rate for Payer: Group Health Inc Commercial |
$377.69
|
| Rate for Payer: Group Health Inc Medicare |
$264.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.69
|
|
|
BACK SUP ULTRALIGN TLSO XL
|
Facility
OP
|
$755.38
|
|
| Hospital Charge Code |
64903746
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.38 |
| Max. Negotiated Rate |
$604.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$415.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$377.69
|
| Rate for Payer: Aetna Government |
$377.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$604.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$513.66
|
| Rate for Payer: Group Health Inc Commercial |
$377.69
|
| Rate for Payer: Group Health Inc Medicare |
$264.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.69
|
|
|
BACK SUP ULTRALIGN TLSO XXL
|
Facility
OP
|
$755.38
|
|
| Hospital Charge Code |
64903748
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$264.38 |
| Max. Negotiated Rate |
$604.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$415.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$377.69
|
| Rate for Payer: Aetna Government |
$377.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$604.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$513.66
|
| Rate for Payer: Group Health Inc Commercial |
$377.69
|
| Rate for Payer: Group Health Inc Medicare |
$264.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$377.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$377.69
|
|
|
BACLOFEN 10 MG TAB
|
Facility
OP
|
$0.10
|
|
| Hospital Charge Code |
41643286
|
|
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: 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
|
|
|
BACLOFEN 10 MG TAB
|
Facility
OP
|
$0.10
|
|
| Hospital Charge Code |
41653286
|
|
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: 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
|
|
|
BACLOFEN 20 MG TAB
|
Facility
OP
|
$0.17
|
|
| Hospital Charge Code |
41643287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
BACLOFEN 20 MG TAB
|
Facility
OP
|
$0.17
|
|
| Hospital Charge Code |
41653287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
BACLOFEN SUSPENSION 5 MG/ML
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41655265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
BACLOFEN SUSPENSION 5 MG/ML
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41645265
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
IP
|
$41,198.26
|
|
|
Service Code
|
MS-DRG 095
|
| Min. Negotiated Rate |
$18,781.56 |
| Max. Negotiated Rate |
$41,198.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$35,155.03
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$40,390.45
|
| Rate for Payer: Aetna Government |
$40,390.45
|
| Rate for Payer: Brighton Health Commercial |
$34,570.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$41,198.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41,172.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33,977.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$38,370.93
|
| Rate for Payer: EmblemHealth Commercial |
$20,444.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$40,390.45
|
| Rate for Payer: Group Health Inc Commercial |
$40,390.45
|
| Rate for Payer: Group Health Inc Medicare |
$40,390.45
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$40,390.45
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,781.56
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$40,390.45
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$40,390.45
|
| Rate for Payer: Wellcare Medicare |
$38,370.93
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
IP
|
$62,560.41
|
|
|
Service Code
|
MS-DRG 094
|
| Min. Negotiated Rate |
$26,767.83 |
| Max. Negotiated Rate |
$62,560.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$53,416.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$57,565.22
|
| Rate for Payer: Aetna Government |
$57,565.22
|
| Rate for Payer: Brighton Health Commercial |
$52,529.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$58,716.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62,560.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$51,627.53
|
| Rate for Payer: Elderplan Medicare Advantage |
$54,686.96
|
| Rate for Payer: EmblemHealth Commercial |
$31,064.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$57,565.22
|
| Rate for Payer: Group Health Inc Commercial |
$57,565.22
|
| Rate for Payer: Group Health Inc Medicare |
$57,565.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$57,565.22
|
| Rate for Payer: Healthfirst Medicare Advantage |
$26,767.83
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$57,565.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$57,565.22
|
| Rate for Payer: Wellcare Medicare |
$54,686.96
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
IP
|
$38,305.67
|
|
|
Service Code
|
MS-DRG 096
|
| Min. Negotiated Rate |
$17,462.88 |
| Max. Negotiated Rate |
$38,305.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$32,139.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$37,554.58
|
| Rate for Payer: Aetna Government |
$37,554.58
|
| Rate for Payer: Brighton Health Commercial |
$31,605.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$38,305.67
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37,641.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$31,063.17
|
| Rate for Payer: Elderplan Medicare Advantage |
$35,676.85
|
| Rate for Payer: EmblemHealth Commercial |
$18,690.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$37,554.58
|
| Rate for Payer: Group Health Inc Commercial |
$37,554.58
|
| Rate for Payer: Group Health Inc Medicare |
$37,554.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37,554.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$17,462.88
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$37,554.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$37,554.58
|
| Rate for Payer: Wellcare Medicare |
$35,676.85
|
|
|
BACTERIAL ANTIGENS COMPLET, URINE
|
Facility
OP
|
$28.85
|
|
|
Service Code
|
HCPCS 86403
|
| Hospital Charge Code |
40728011
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.54
|
| Rate for Payer: Aetna Government |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.54
|
| Rate for Payer: EmblemHealth Commercial |
$11.54
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.39
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.81
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.27
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.54
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.27
|
| Rate for Payer: Group Health Inc Commercial |
$11.54
|
| Rate for Payer: Group Health Inc Medicare |
$11.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.54
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.54
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.54
|
| Rate for Payer: Healthfirst QHP |
$11.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.54
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.23
|
| Rate for Payer: Wellcare Medicare |
$10.39
|
|
|
BACTERIAL REPLACEMENT FILTER
|
Facility
OP
|
$1,012.40
|
|
| Hospital Charge Code |
64902960
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$354.34 |
| Max. Negotiated Rate |
$809.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$556.82
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$506.20
|
| Rate for Payer: Aetna Government |
$506.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$809.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$688.43
|
| Rate for Payer: Group Health Inc Commercial |
$506.20
|
| Rate for Payer: Group Health Inc Medicare |
$354.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$506.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$506.20
|
|
|
BACTERIOLOGIC STUDIES FOR DETERM.
|
Facility
OP
|
$141.75
|
|
|
Service Code
|
HCPCS D0415
|
| Hospital Charge Code |
42300195
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$77.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.68
|
| Rate for Payer: Aetna Government |
$10.68
|
| 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: Group Health Inc Commercial |
$70.88
|
| Rate for Payer: Group Health Inc Medicare |
$49.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$70.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$70.88
|
|
|
BACTOSHIELD CHG 4% STERIS
|
Facility
OP
|
$47.39
|
|
| Hospital Charge Code |
64902774
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$37.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$23.70
|
| Rate for Payer: Aetna Government |
$23.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$37.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32.23
|
| Rate for Payer: Group Health Inc Commercial |
$23.70
|
| Rate for Payer: Group Health Inc Medicare |
$16.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$23.70
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$23.70
|
|
