|
SENSOR, NEONATAL ADHESIVE SET
|
Facility
OP
|
$23.75
|
|
| Hospital Charge Code |
64902149
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.88
|
| Rate for Payer: Aetna Government |
$11.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Group Health Inc Commercial |
$11.88
|
| Rate for Payer: Group Health Inc Medicare |
$8.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
|
|
SENSOR NEONATAL/ADULT
|
Facility
OP
|
$25.63
|
|
| Hospital Charge Code |
64902441
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.82
|
| Rate for Payer: Aetna Government |
$12.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.43
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
|
|
SENSOR NEONATAL NEOPT-L
|
Facility
OP
|
$25.63
|
|
| Hospital Charge Code |
64902442
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.82
|
| Rate for Payer: Aetna Government |
$12.82
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17.43
|
| Rate for Payer: Group Health Inc Commercial |
$12.82
|
| Rate for Payer: Group Health Inc Medicare |
$8.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.82
|
|
|
SENSOR, NEOPT ADHES SOFTOUCH
|
Facility
OP
|
$23.75
|
|
| Hospital Charge Code |
64902151
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.88
|
| Rate for Payer: Aetna Government |
$11.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.15
|
| Rate for Payer: Group Health Inc Commercial |
$11.88
|
| Rate for Payer: Group Health Inc Medicare |
$8.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.88
|
|
|
SENSOR O2 FOR DRAGER ANES MACH
|
Facility
OP
|
$337.50
|
|
| Hospital Charge Code |
64903231
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$185.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$168.75
|
| Rate for Payer: Aetna Government |
$168.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$270.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$229.50
|
| Rate for Payer: Group Health Inc Commercial |
$168.75
|
| Rate for Payer: Group Health Inc Medicare |
$118.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$168.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$168.75
|
|
|
SENSOR RECTAL TEMP 9FR
|
Facility
OP
|
$14.10
|
|
| Hospital Charge Code |
64901654
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$11.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.05
|
| Rate for Payer: Aetna Government |
$7.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.59
|
| Rate for Payer: Group Health Inc Commercial |
$7.05
|
| Rate for Payer: Group Health Inc Medicare |
$4.94
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.05
|
|
|
SENSOR SEDLINE EEG 2479
|
Facility
OP
|
$33.75
|
|
| Hospital Charge Code |
64906830
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.88
|
| Rate for Payer: Aetna Government |
$16.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.95
|
| Rate for Payer: Group Health Inc Commercial |
$16.88
|
| Rate for Payer: Group Health Inc Medicare |
$11.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.88
|
|
|
SENSOR SPIROLOG FOR ANES MACHINE
|
Facility
OP
|
$51.80
|
|
| Hospital Charge Code |
64903296
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$41.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25.90
|
| Rate for Payer: Aetna Government |
$25.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$41.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$35.22
|
| Rate for Payer: Group Health Inc Commercial |
$25.90
|
| Rate for Payer: Group Health Inc Medicare |
$18.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25.90
|
|
|
SENSOR, SPO2, ADHS, M-LNCS,INFANT
|
Facility
OP
|
$19.30
|
|
| Hospital Charge Code |
64906210
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$15.44 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.65
|
| Rate for Payer: Aetna Government |
$9.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.12
|
| Rate for Payer: Group Health Inc Commercial |
$9.65
|
| Rate for Payer: Group Health Inc Medicare |
$6.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.65
|
|
|
SENSOR SPO2 ADULT RAINBOW 3792
|
Facility
OP
|
$200.00
|
|
| Hospital Charge Code |
64906832
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$160.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$110.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$100.00
|
| Rate for Payer: Aetna Government |
$100.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$160.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$136.00
|
| Rate for Payer: Group Health Inc Commercial |
$100.00
|
| Rate for Payer: Group Health Inc Medicare |
$70.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$100.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$100.00
|
|
|
SENSOR SPO2 PEDS RAINBOW 2414
|
Facility
OP
|
$190.00
|
|
| Hospital Charge Code |
64906831
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$95.00
|
| Rate for Payer: Aetna Government |
$95.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$152.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$129.20
|
| Rate for Payer: Group Health Inc Commercial |
$95.00
|
| Rate for Payer: Group Health Inc Medicare |
$66.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$95.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$95.00
|
|
|
SENSOR WIRE .038 ANGLED TIP
|
Facility
OP
|
$121.95
|
|
| Hospital Charge Code |
64905411
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$97.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$67.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$60.98
|
| Rate for Payer: Aetna Government |
$60.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$97.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$82.93
|
| Rate for Payer: Group Health Inc Commercial |
$60.98
|
| Rate for Payer: Group Health Inc Medicare |
$42.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$60.98
|
|
|
SENSORY INTEGRATION EA 15M
|
Facility
OP
|
$153.25
|
|
|
Service Code
|
HCPCS 97533
|
| Hospital Charge Code |
41904877
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$17.32 |
| Max. Negotiated Rate |
$5,078.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$84.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.32
|
| Rate for Payer: Aetna Government |
$17.32
|
| Rate for Payer: Amida Care Medicaid |
$50.78
|
| Rate for Payer: Brighton Health Commercial |
$182.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$147.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$124.95
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$5,078.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$50.78
|
| Rate for Payer: Fidelis Essential Plan QHP |
$50.78
|
| Rate for Payer: Fidelis Qualified Health Plan |
$53.32
|
| Rate for Payer: Group Health Inc Commercial |
$76.62
|
| Rate for Payer: Group Health Inc Medicare |
$120.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$50.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$76.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$50.78
|
| Rate for Payer: Healthfirst Essential Plan |
$114.26
|
| Rate for Payer: Healthfirst QHP |
$50.78
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$50.78
|
| Rate for Payer: SOMOS Essential |
$114.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.78
|
| Rate for Payer: Wellcare Medicare |
$55.00
|
|
|
SENSR WIRE .035 STRAIGHT TIP
|
Facility
OP
|
$108.65
|
|
| Hospital Charge Code |
64905407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$86.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.32
|
| Rate for Payer: Aetna Government |
$54.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$86.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$73.88
|
| Rate for Payer: Group Health Inc Commercial |
$54.32
|
| Rate for Payer: Group Health Inc Medicare |
$38.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$54.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.32
|
|
|
SEPARATOR 4(SEPC4)
|
Facility
OP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
64906783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.66 |
| Max. Negotiated Rate |
$2,005.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,050.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$550.66
|
| Rate for Payer: Aetna Government |
$550.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$955.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,098.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,005.50
|
| Rate for Payer: Group Health Inc Commercial |
$955.00
|
| Rate for Payer: Group Health Inc Medicare |
$668.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$955.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$955.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,241.50
|
|
|
SEPARATOR 4(SEPC4)
|
Facility
IP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1778
|
| Hospital Charge Code |
64906783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$955.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$955.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$955.00
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
IP
|
$24,535.77
|
|
|
Service Code
|
MS-DRG 549
|
| Min. Negotiated Rate |
$10,343.20 |
| Max. Negotiated Rate |
$24,535.77 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$17,785.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24,054.68
|
| Rate for Payer: Aetna Government |
$24,054.68
|
| Rate for Payer: Brighton Health Commercial |
$17,489.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24,535.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$20,829.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$17,189.70
|
| Rate for Payer: Elderplan Medicare Advantage |
$22,851.95
|
| Rate for Payer: EmblemHealth Commercial |
$10,343.20
|
| Rate for Payer: Fidelis Medicare Advantage |
$24,054.68
|
| Rate for Payer: Group Health Inc Commercial |
$24,054.68
|
| Rate for Payer: Group Health Inc Medicare |
$24,054.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24,054.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,185.43
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24,054.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24,054.68
|
| Rate for Payer: Wellcare Medicare |
$22,851.95
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
IP
|
$35,053.79
|
|
|
Service Code
|
MS-DRG 548
|
| Min. Negotiated Rate |
$15,980.40 |
| Max. Negotiated Rate |
$35,053.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,749.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,366.46
|
| Rate for Payer: Aetna Government |
$34,366.46
|
| Rate for Payer: Brighton Health Commercial |
$28,272.10
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,053.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,671.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,786.83
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,648.14
|
| Rate for Payer: EmblemHealth Commercial |
$16,719.50
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,366.46
|
| Rate for Payer: Group Health Inc Commercial |
$34,366.46
|
| Rate for Payer: Group Health Inc Medicare |
$34,366.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,366.46
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,980.40
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,366.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,366.46
|
| Rate for Payer: Wellcare Medicare |
$32,648.14
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
IP
|
$20,819.95
|
|
|
Service Code
|
MS-DRG 550
|
| Min. Negotiated Rate |
$7,895.86 |
| Max. Negotiated Rate |
$20,819.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,577.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,411.72
|
| Rate for Payer: Aetna Government |
$20,411.72
|
| Rate for Payer: Brighton Health Commercial |
$13,351.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,819.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16,293.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,445.93
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,391.13
|
| Rate for Payer: EmblemHealth Commercial |
$7,895.86
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,411.72
|
| Rate for Payer: Group Health Inc Commercial |
$20,411.72
|
| Rate for Payer: Group Health Inc Medicare |
$20,411.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,411.72
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,491.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,411.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,411.72
|
| Rate for Payer: Wellcare Medicare |
$19,391.13
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
IP
|
$120,276.86
|
|
|
Service Code
|
MS-DRG 870
|
| Min. Negotiated Rate |
$48,319.45 |
| Max. Negotiated Rate |
$120,276.86 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$102,697.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$103,912.79
|
| Rate for Payer: Aetna Government |
$103,912.79
|
| Rate for Payer: Brighton Health Commercial |
$100,991.05
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$105,991.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$120,276.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$99,257.63
|
| Rate for Payer: Elderplan Medicare Advantage |
$98,717.15
|
| Rate for Payer: EmblemHealth Commercial |
$59,724.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$103,912.79
|
| Rate for Payer: Group Health Inc Commercial |
$103,912.79
|
| Rate for Payer: Group Health Inc Medicare |
$103,912.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$103,912.79
|
| Rate for Payer: Healthfirst Medicare Advantage |
$48,319.45
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$103,912.79
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$103,912.79
|
| Rate for Payer: Wellcare Medicare |
$98,717.15
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
IP
|
$35,517.75
|
|
|
Service Code
|
MS-DRG 871
|
| Min. Negotiated Rate |
$16,191.91 |
| Max. Negotiated Rate |
$35,517.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$29,233.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,821.32
|
| Rate for Payer: Aetna Government |
$34,821.32
|
| Rate for Payer: Brighton Health Commercial |
$28,747.70
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,517.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34,237.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$28,254.27
|
| Rate for Payer: Elderplan Medicare Advantage |
$33,080.25
|
| Rate for Payer: EmblemHealth Commercial |
$17,000.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,821.32
|
| Rate for Payer: Group Health Inc Commercial |
$34,821.32
|
| Rate for Payer: Group Health Inc Medicare |
$34,821.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,821.32
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,191.91
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,821.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,821.32
|
| Rate for Payer: Wellcare Medicare |
$33,080.25
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
IP
|
$22,042.07
|
|
|
Service Code
|
MS-DRG 872
|
| Min. Negotiated Rate |
$8,831.39 |
| Max. Negotiated Rate |
$22,042.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,185.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,609.87
|
| Rate for Payer: Aetna Government |
$21,609.87
|
| Rate for Payer: Brighton Health Commercial |
$14,933.55
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,042.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,785.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,677.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,529.38
|
| Rate for Payer: EmblemHealth Commercial |
$8,831.39
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,609.87
|
| Rate for Payer: Group Health Inc Commercial |
$21,609.87
|
| Rate for Payer: Group Health Inc Medicare |
$21,609.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,609.87
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,048.59
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,609.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,609.87
|
| Rate for Payer: Wellcare Medicare |
$20,529.38
|
|
|
SEPTOPLASTY
|
Facility
OP
|
$7,933.18
|
|
|
Service Code
|
HCPCS 30520
|
| Hospital Charge Code |
40109035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$756.33 |
| Max. Negotiated Rate |
$3,966.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Cash Price |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$756.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,966.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$840.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft
|
Facility
OP
|
$3,723.23
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$756.33 |
| Max. Negotiated Rate |
$3,723.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2,485.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3,723.23
|
| Rate for Payer: Aetna Government |
$3,723.23
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$3,723.23
|
| 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 |
$3,723.23
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$756.33
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$3,164.75
|
| Rate for Payer: Fidelis Essential Plan QHP |
$3,313.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,723.23
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,313.67
|
| Rate for Payer: Group Health Inc Commercial |
$3,723.23
|
| Rate for Payer: Group Health Inc Medicare |
$3,723.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3,723.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$840.37
|
| Rate for Payer: Healthfirst Medicare Advantage |
$3,164.75
|
| Rate for Payer: Healthfirst QHP |
$3,723.23
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$3,723.23
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3,723.23
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$2,978.58
|
| Rate for Payer: Wellcare Medicare |
$3,537.07
|
|
|
SEQUESTRECTOMY FOR OSTEOMYLELITIS
|
Facility
OP
|
$851.00
|
|
|
Service Code
|
HCPCS D7550
|
| Hospital Charge Code |
42301850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$425.50 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$468.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,018.19
|
| Rate for Payer: Aetna Government |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Cash Price |
$1,018.19
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,018.19
|
| 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 |
$1,018.19
|
| Rate for Payer: EmblemHealth Commercial |
$1,018.19
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$865.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$906.19
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,018.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$906.19
|
| Rate for Payer: Group Health Inc Commercial |
$1,018.19
|
| Rate for Payer: Group Health Inc Medicare |
$1,018.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$425.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,018.19
|
| Rate for Payer: Healthfirst Medicare Advantage |
$865.46
|
| Rate for Payer: Healthfirst QHP |
$1,018.19
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,018.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,018.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$967.28
|
|
