|
BICALUTAMIDE 50 MG TAB
|
Facility
OP
|
$2.10
|
|
| Hospital Charge Code |
41642629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.05
|
| Rate for Payer: Aetna Government |
$1.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.36
|
|
|
BICARBONATE STERILYTE
|
Facility
OP
|
$9.81
|
|
| Hospital Charge Code |
64902072
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.90
|
| Rate for Payer: Aetna Government |
$4.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.85
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.67
|
| Rate for Payer: Group Health Inc Commercial |
$4.90
|
| Rate for Payer: Group Health Inc Medicare |
$3.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.90
|
|
|
BICILLIN CR 900-300MU
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41654790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
BICILLIN CR 900-300MU
|
Facility
IP
|
$0.17
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41644790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
|
|
BICILLIN CR 900-300MU
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41654790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.58
|
| Rate for Payer: Aetna Government |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.58
|
| Rate for Payer: EmblemHealth Commercial |
$17.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.46
|
| Rate for Payer: Group Health Inc Commercial |
$17.58
|
| Rate for Payer: Group Health Inc Medicare |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.94
|
| Rate for Payer: Healthfirst QHP |
$17.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: SOMOS Essential |
$18.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.06
|
| Rate for Payer: Wellcare Medicare |
$16.70
|
|
|
BICILLIN CR 900-300MU
|
Facility
OP
|
$0.17
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
41644790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$17.58
|
| Rate for Payer: Aetna Government |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$17.58
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Elderplan Medicare Advantage |
$17.58
|
| Rate for Payer: EmblemHealth Commercial |
$17.58
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17.58
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.58
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.46
|
| Rate for Payer: Fidelis Medicare Advantage |
$17.58
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.46
|
| Rate for Payer: Group Health Inc Commercial |
$17.58
|
| Rate for Payer: Group Health Inc Medicare |
$17.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$15.67
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.94
|
| Rate for Payer: Healthfirst QHP |
$17.58
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$17.58
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18.41
|
| Rate for Payer: SOMOS Essential |
$18.41
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$14.06
|
| Rate for Payer: Wellcare Medicare |
$16.70
|
|
|
BICTEGRAVIR/EMTRICITABINE/TENOFOV
|
Facility
OP
|
$245.23
|
|
| Hospital Charge Code |
41658888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$196.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.62
|
| Rate for Payer: Aetna Government |
$122.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.76
|
| Rate for Payer: Group Health Inc Commercial |
$122.62
|
| Rate for Payer: Group Health Inc Medicare |
$85.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.40
|
|
|
BICTEGRAVIR/EMTRICITABINE/TENOFOV
|
Facility
OP
|
$245.23
|
|
| Hospital Charge Code |
41648888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.83 |
| Max. Negotiated Rate |
$196.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.88
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$122.62
|
| Rate for Payer: Aetna Government |
$122.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$196.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$166.76
|
| Rate for Payer: Group Health Inc Commercial |
$122.62
|
| Rate for Payer: Group Health Inc Medicare |
$85.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.40
|
|
|
BI CUT SYS REAM SHFT 8.0MMX448MM
|
Facility
OP
|
$537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$187.95 |
| Max. Negotiated Rate |
$563.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$295.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$268.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$308.78
|
| Rate for Payer: Fidelis Medicare Advantage |
$563.85
|
| Rate for Payer: Group Health Inc Commercial |
$268.50
|
| Rate for Payer: Group Health Inc Medicare |
$187.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$349.05
|
|
|
BI CUT SYS REAM SHFT 8.0MMX448MM
|
Facility
IP
|
$537.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40206075
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$268.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$268.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$268.50
|
|
|
BIFURCATED GRAFT
|
Facility
OP
|
$22,590.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40202226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$322.77 |
| Max. Negotiated Rate |
$23,719.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$12,424.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$322.77
|
| Rate for Payer: Aetna Government |
$322.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,295.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,989.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$23,719.50
|
| Rate for Payer: Group Health Inc Commercial |
$11,295.00
|
| Rate for Payer: Group Health Inc Medicare |
$7,906.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,295.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14,683.50
|
|
|
BIFURCATED GRAFT
|
Facility
IP
|
$22,590.00
|
|
|
Service Code
|
HCPCS C1768
|
| Hospital Charge Code |
40202226
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,295.00 |
| Max. Negotiated Rate |
$11,295.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$11,295.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11,295.00
|
|
|
BILARY STENT EXCHANGE SYS 10X15
|
Facility
IP
|
$258.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40202747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$129.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.00
|
|
|
BILARY STENT EXCHANGE SYS 10X15
|
Facility
OP
|
$258.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
40202747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$270.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$141.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.08
|
| Rate for Payer: Aetna Government |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$129.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$148.35
|
| Rate for Payer: Fidelis Medicare Advantage |
$270.90
|
| Rate for Payer: Group Health Inc Commercial |
$129.00
|
| Rate for Payer: Group Health Inc Medicare |
$90.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$129.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$129.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$167.70
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC
|
Facility
IP
|
$117,748.68
|
|
|
Service Code
|
MS-DRG 461
|
| Min. Negotiated Rate |
$47,375.41 |
| Max. Negotiated Rate |
$117,748.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$100,538.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$101,882.61
|
| Rate for Payer: Aetna Government |
$101,882.61
|
| Rate for Payer: Brighton Health Commercial |
$98,868.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$103,920.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$117,748.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$97,171.26
|
| Rate for Payer: Elderplan Medicare Advantage |
$96,788.48
|
| Rate for Payer: EmblemHealth Commercial |
$58,468.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$101,882.61
|
| Rate for Payer: Group Health Inc Commercial |
$101,882.61
|
| Rate for Payer: Group Health Inc Medicare |
$101,882.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$101,882.61
|
| Rate for Payer: Healthfirst Medicare Advantage |
$47,375.41
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$101,882.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$101,882.61
|
| Rate for Payer: Wellcare Medicare |
$96,788.48
|
|
|
BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC
|
Facility
IP
|
$49,152.75
|
|
|
Service Code
|
MS-DRG 462
|
| Min. Negotiated Rate |
$21,761.34 |
| Max. Negotiated Rate |
$49,152.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41,968.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$46,798.58
|
| Rate for Payer: Aetna Government |
$46,798.58
|
| Rate for Payer: Brighton Health Commercial |
$41,271.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$47,734.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49,152.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$40,562.96
|
| Rate for Payer: Elderplan Medicare Advantage |
$44,458.65
|
| Rate for Payer: EmblemHealth Commercial |
$24,407.00
|
| Rate for Payer: Fidelis Medicare Advantage |
$46,798.58
|
| Rate for Payer: Group Health Inc Commercial |
$46,798.58
|
| Rate for Payer: Group Health Inc Medicare |
$46,798.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$46,798.58
|
| Rate for Payer: Healthfirst Medicare Advantage |
$21,761.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$46,798.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$46,798.58
|
| Rate for Payer: Wellcare Medicare |
$44,458.65
|
|
|
BILAT MAST/HX BI/UNILA MAS
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS G9708
|
| Hospital Charge Code |
30307874
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
BILE ACIDS, FRACTIONATED LCMS
|
Facility
OP
|
$60.23
|
|
|
Service Code
|
HCPCS 82542
|
| Hospital Charge Code |
40609056
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$33.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33.13
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.09
|
| Rate for Payer: Aetna Government |
$24.09
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Cash Price |
$24.09
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$28.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.29
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.09
|
| Rate for Payer: EmblemHealth Commercial |
$24.09
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21.68
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.48
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.44
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.09
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.44
|
| Rate for Payer: Group Health Inc Commercial |
$24.09
|
| Rate for Payer: Group Health Inc Medicare |
$24.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$30.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.09
|
| Rate for Payer: Healthfirst Medicare Advantage |
$24.09
|
| Rate for Payer: Healthfirst QHP |
$24.09
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.09
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19.27
|
| Rate for Payer: Wellcare Medicare |
$21.68
|
|
|
Bile Bags
|
Facility
OP
|
$125.80
|
|
| Hospital Charge Code |
40200608
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$44.03 |
| Max. Negotiated Rate |
$100.64 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$69.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.90
|
| Rate for Payer: Aetna Government |
$62.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$100.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$85.54
|
| Rate for Payer: Group Health Inc Commercial |
$62.90
|
| Rate for Payer: Group Health Inc Medicare |
$44.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$62.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.90
|
|
|
BILE BAGS
|
Facility
OP
|
$9.57
|
|
| Hospital Charge Code |
40200015
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$7.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.78
|
| Rate for Payer: Aetna Government |
$4.78
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.51
|
| Rate for Payer: Group Health Inc Commercial |
$4.78
|
| Rate for Payer: Group Health Inc Medicare |
$3.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.78
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC
|
Facility
IP
|
$35,159.90
|
|
|
Service Code
|
MS-DRG 409
|
| Min. Negotiated Rate |
$16,028.78 |
| Max. Negotiated Rate |
$35,159.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,860.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$34,470.49
|
| Rate for Payer: Aetna Government |
$34,470.49
|
| Rate for Payer: Brighton Health Commercial |
$28,380.85
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$35,159.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,800.61
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,893.72
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,746.97
|
| Rate for Payer: EmblemHealth Commercial |
$16,783.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$34,470.49
|
| Rate for Payer: Group Health Inc Commercial |
$34,470.49
|
| Rate for Payer: Group Health Inc Medicare |
$34,470.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$34,470.49
|
| Rate for Payer: Healthfirst Medicare Advantage |
$16,028.78
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$34,470.49
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$34,470.49
|
| Rate for Payer: Wellcare Medicare |
$32,746.97
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC
|
Facility
IP
|
$64,278.67
|
|
|
Service Code
|
MS-DRG 408
|
| Min. Negotiated Rate |
$27,409.42 |
| Max. Negotiated Rate |
$64,278.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$54,883.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$58,945.00
|
| Rate for Payer: Aetna Government |
$58,945.00
|
| Rate for Payer: Brighton Health Commercial |
$53,971.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$60,123.90
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$64,278.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53,045.52
|
| Rate for Payer: Elderplan Medicare Advantage |
$55,997.75
|
| Rate for Payer: EmblemHealth Commercial |
$31,917.90
|
| Rate for Payer: Fidelis Medicare Advantage |
$58,945.00
|
| Rate for Payer: Group Health Inc Commercial |
$58,945.00
|
| Rate for Payer: Group Health Inc Medicare |
$58,945.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$58,945.00
|
| Rate for Payer: Healthfirst Medicare Advantage |
$27,409.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$58,945.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58,945.00
|
| Rate for Payer: Wellcare Medicare |
$55,997.75
|
|
|
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
IP
|
$29,613.72
|
|
|
Service Code
|
MS-DRG 410
|
| Min. Negotiated Rate |
$13,421.60 |
| Max. Negotiated Rate |
$29,613.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23,078.87
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$29,033.06
|
| Rate for Payer: Aetna Government |
$29,033.06
|
| Rate for Payer: Brighton Health Commercial |
$22,695.40
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$29,613.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$27,029.44
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22,305.85
|
| Rate for Payer: Elderplan Medicare Advantage |
$27,581.41
|
| Rate for Payer: EmblemHealth Commercial |
$13,421.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$29,033.06
|
| Rate for Payer: Group Health Inc Commercial |
$29,033.06
|
| Rate for Payer: Group Health Inc Medicare |
$29,033.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$29,033.06
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,500.37
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$29,033.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29,033.06
|
| Rate for Payer: Wellcare Medicare |
$27,581.41
|
|
|
BILIRUBIN (DIRECT)
|
Facility
OP
|
$12.55
|
|
|
Service Code
|
HCPCS 82248
|
| Hospital Charge Code |
40602145
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
|
BILIRUBIN (TOTAL)
|
Facility
OP
|
$12.55
|
|
|
Service Code
|
HCPCS 82247
|
| Hospital Charge Code |
40602140
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.02
|
| Rate for Payer: Aetna Government |
$5.02
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Cash Price |
$5.02
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$5.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$5.02
|
| Rate for Payer: EmblemHealth Commercial |
$5.02
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$4.52
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$4.27
|
| Rate for Payer: Fidelis Essential Plan QHP |
$4.47
|
| Rate for Payer: Fidelis Medicare Advantage |
$5.02
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4.47
|
| Rate for Payer: Group Health Inc Commercial |
$5.02
|
| Rate for Payer: Group Health Inc Medicare |
$5.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.02
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$5.02
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.02
|
| Rate for Payer: Healthfirst QHP |
$5.02
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$5.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.02
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$4.02
|
| Rate for Payer: Wellcare Medicare |
$4.52
|
|
