|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
IP
|
$8.71
|
|
|
Service Code
|
NDC 0093317431
|
| Hospital Charge Code |
0093317431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
IP
|
$10.35
|
|
|
Service Code
|
NDC 5931057922
|
| Hospital Charge Code |
5931057922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.17
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
NDC 6675895985
|
| Hospital Charge Code |
6675895985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.14
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
OP
|
$6.71
|
|
|
Service Code
|
NDC 0781729685
|
| Hospital Charge Code |
0781729685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$5.37 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.36
|
| Rate for Payer: Aetna Government |
$3.36
|
| Rate for Payer: Brighton Health Commercial |
$5.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.56
|
| Rate for Payer: EmblemHealth Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.36
|
| Rate for Payer: Group Health Inc Medicare |
$2.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.36
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
OP
|
$8.71
|
|
|
Service Code
|
NDC 0093317431
|
| Hospital Charge Code |
0093317431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.35
|
| Rate for Payer: Aetna Government |
$4.35
|
| Rate for Payer: Brighton Health Commercial |
$6.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.92
|
| Rate for Payer: EmblemHealth Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Commercial |
$4.35
|
| Rate for Payer: Group Health Inc Medicare |
$3.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.66
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
NDC 0173068220
|
| Hospital Charge Code |
0173068220
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.90
|
| Rate for Payer: Aetna Government |
$1.90
|
| Rate for Payer: Brighton Health Commercial |
$2.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.58
|
| Rate for Payer: EmblemHealth Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Commercial |
$1.90
|
| Rate for Payer: Group Health Inc Medicare |
$1.33
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.47
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
NDC 6699301968
|
| Hospital Charge Code |
6699301968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.73
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
IP
|
$8.71
|
|
|
Service Code
|
NDC 6818096301
|
| Hospital Charge Code |
6818096301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.35
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
IP
|
$13.57
|
|
|
Service Code
|
NDC 0054074287
|
| Hospital Charge Code |
0054074287
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.78 |
| Max. Negotiated Rate |
$6.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.78
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
OP
|
$3.47
|
|
|
Service Code
|
NDC 6699301968
|
| Hospital Charge Code |
6699301968
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.73
|
| Rate for Payer: Aetna Government |
$1.73
|
| Rate for Payer: Brighton Health Commercial |
$2.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.36
|
| Rate for Payer: EmblemHealth Commercial |
$1.73
|
| Rate for Payer: Group Health Inc Commercial |
$1.73
|
| Rate for Payer: Group Health Inc Medicare |
$1.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.25
|
|
|
ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
NDC 6675895985
|
| Hospital Charge Code |
6675895985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.14
|
| Rate for Payer: Aetna Government |
$7.14
|
| Rate for Payer: Brighton Health Commercial |
$10.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.71
|
| Rate for Payer: EmblemHealth Commercial |
$7.14
|
| Rate for Payer: Group Health Inc Commercial |
$7.14
|
| Rate for Payer: Group Health Inc Medicare |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.14
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.28
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
OP
|
$263.93
|
|
|
Service Code
|
EAPG 00842
|
| Min. Negotiated Rate |
$185.14 |
| Max. Negotiated Rate |
$263.93 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$185.14
|
| Rate for Payer: Healthfirst Commercial |
$263.93
|
|
|
Alcohol abuse & dependence
|
Facility
|
IP
|
$12,787.00
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$3,416.75 |
| Max. Negotiated Rate |
$12,787.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,416.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,416.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,416.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,416.75
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,687.69
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,416.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,100.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,416.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,416.75
|
| Rate for Payer: Healthfirst Commercial |
$12,787.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,687.69
|
| Rate for Payer: Healthfirst QHP |
$6,218.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,416.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,687.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,687.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,416.75
|
| Rate for Payer: SOMOS Essential |
$7,687.69
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,687.69
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,687.69
|
| Rate for Payer: United Healthcare Medicaid |
$3,416.75
|
|
|
Alcohol abuse & dependence
|
Facility
|
IP
|
$50,611.00
|
|
|
Service Code
|
APR-DRG 7754
|
| Min. Negotiated Rate |
$3,416.75 |
| Max. Negotiated Rate |
$50,611.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,416.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,416.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,416.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,416.75
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,687.69
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,416.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,100.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,416.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,416.75
|
| Rate for Payer: Healthfirst Commercial |
$50,611.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,687.69
|
| Rate for Payer: Healthfirst QHP |
$6,218.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,416.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,687.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,687.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,416.75
|
| Rate for Payer: SOMOS Essential |
$7,687.69
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,687.69
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,687.69
|
| Rate for Payer: United Healthcare Medicaid |
$3,416.75
|
|
|
Alcohol abuse & dependence
|
Facility
|
IP
|
$21,528.00
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$3,416.75 |
| Max. Negotiated Rate |
$21,528.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,416.75
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,416.75
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,416.75
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,416.75
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,687.69
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,416.75
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,100.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,416.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,416.75
|
| Rate for Payer: Healthfirst Commercial |
$21,528.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,687.69
|
| Rate for Payer: Healthfirst QHP |
$6,218.48
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,416.75
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,687.69
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,687.69
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,416.75
|
| Rate for Payer: SOMOS Essential |
$7,687.69
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,687.69
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,687.69
|
| Rate for Payer: United Healthcare Medicaid |
$3,416.75
|
|
|
Alcohol abuse & dependence
|
Facility
|
IP
|
$10,874.00
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$3,361.35 |
| Max. Negotiated Rate |
$10,874.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,361.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,361.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,361.35
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,361.35
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,563.04
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,361.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$4,033.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,361.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,361.35
|
| Rate for Payer: Healthfirst Commercial |
$10,874.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,563.04
|
| Rate for Payer: Healthfirst QHP |
$6,117.66
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,361.35
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,563.04
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,563.04
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,361.35
|
| Rate for Payer: SOMOS Essential |
$7,563.04
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,563.04
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,563.04
|
| Rate for Payer: United Healthcare Medicaid |
$3,361.35
|
|
|
Alcohol & drug dependence w rehab or rehab/detox therapy
|
Facility
|
IP
|
$26,091.00
|
|
|
Service Code
|
APR-DRG 7722
|
| Min. Negotiated Rate |
$3,164.48 |
| Max. Negotiated Rate |
$26,091.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,164.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,164.48
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,164.48
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,797.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst Commercial |
$26,091.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,120.08
|
| Rate for Payer: Healthfirst QHP |
$5,759.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,164.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,120.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,120.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,164.48
|
| Rate for Payer: SOMOS Essential |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,120.08
|
| Rate for Payer: United Healthcare Medicaid |
$3,164.48
|
|
|
Alcohol & drug dependence w rehab or rehab/detox therapy
|
Facility
|
IP
|
$26,091.00
|
|
|
Service Code
|
APR-DRG 7723
|
| Min. Negotiated Rate |
$3,164.48 |
| Max. Negotiated Rate |
$26,091.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,164.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,164.48
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,164.48
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,797.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst Commercial |
$26,091.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,120.08
|
| Rate for Payer: Healthfirst QHP |
$5,759.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,164.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,120.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,120.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,164.48
|
| Rate for Payer: SOMOS Essential |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,120.08
|
| Rate for Payer: United Healthcare Medicaid |
$3,164.48
|
|
|
Alcohol & drug dependence w rehab or rehab/detox therapy
|
Facility
|
IP
|
$26,091.00
|
|
|
Service Code
|
APR-DRG 7724
|
| Min. Negotiated Rate |
$3,164.48 |
| Max. Negotiated Rate |
$26,091.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,164.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,164.48
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,164.48
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,797.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst Commercial |
$26,091.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,120.08
|
| Rate for Payer: Healthfirst QHP |
$5,759.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,164.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,120.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,120.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,164.48
|
| Rate for Payer: SOMOS Essential |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,120.08
|
| Rate for Payer: United Healthcare Medicaid |
$3,164.48
|
|
|
Alcohol & drug dependence w rehab or rehab/detox therapy
|
Facility
|
IP
|
$26,091.00
|
|
|
Service Code
|
APR-DRG 7721
|
| Min. Negotiated Rate |
$3,164.48 |
| Max. Negotiated Rate |
$26,091.00 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$3,164.48
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$3,164.48
|
| Rate for Payer: Carelon Behavioral Health HARP/QHP |
$3,164.48
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$3,164.48
|
| Rate for Payer: Fidelis Qualified Health Plan |
$3,797.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,164.48
|
| Rate for Payer: Healthfirst Commercial |
$26,091.00
|
| Rate for Payer: Healthfirst Essential Plan |
$7,120.08
|
| Rate for Payer: Healthfirst QHP |
$5,759.35
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$3,164.48
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$7,120.08
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$7,120.08
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3,164.48
|
| Rate for Payer: SOMOS Essential |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$7,120.08
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$7,120.08
|
| Rate for Payer: United Healthcare Medicaid |
$3,164.48
|
|
|
Alcoholic liver disease
|
Facility
|
IP
|
$92,030.35
|
|
|
Service Code
|
APR-DRG 2804
|
| Min. Negotiated Rate |
$30,753.00 |
| Max. Negotiated Rate |
$92,030.35 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$92,030.35
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$92,030.35
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$40,902.38
|
| Rate for Payer: Amida Care Medicaid |
$40,902.38
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$92,030.35
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$40,902.38
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$40,902.38
|
| Rate for Payer: Fidelis Qualified Health Plan |
$49,082.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$40,902.38
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$40,902.38
|
| Rate for Payer: Healthfirst Commercial |
$55,076.00
|
| Rate for Payer: Healthfirst Essential Plan |
$92,030.35
|
| Rate for Payer: Healthfirst QHP |
$30,753.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$40,902.38
|
| Rate for Payer: SOMOS Essential |
$92,030.35
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$92,030.35
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$92,030.35
|
| Rate for Payer: United Healthcare Medicaid |
$40,902.38
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$40,902.38
|
|
|
Alcoholic liver disease
|
Facility
|
IP
|
$45,260.03
|
|
|
Service Code
|
APR-DRG 2802
|
| Min. Negotiated Rate |
$8,496.00 |
| Max. Negotiated Rate |
$45,260.03 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$45,260.03
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$45,260.03
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$20,115.57
|
| Rate for Payer: Amida Care Medicaid |
$20,115.57
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$45,260.03
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$20,115.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$20,115.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$24,138.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$20,115.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20,115.57
|
| Rate for Payer: Healthfirst Commercial |
$13,429.00
|
| Rate for Payer: Healthfirst Essential Plan |
$45,260.03
|
| Rate for Payer: Healthfirst QHP |
$8,496.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$20,115.57
|
| Rate for Payer: SOMOS Essential |
$45,260.03
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$45,260.03
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$45,260.03
|
| Rate for Payer: United Healthcare Medicaid |
$20,115.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$20,115.57
|
|
|
Alcoholic liver disease
|
Facility
|
IP
|
$41,441.78
|
|
|
Service Code
|
APR-DRG 2801
|
| Min. Negotiated Rate |
$6,655.00 |
| Max. Negotiated Rate |
$41,441.78 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,441.78
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,441.78
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,418.57
|
| Rate for Payer: Amida Care Medicaid |
$18,418.57
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,441.78
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,418.57
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,418.57
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,102.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,418.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,418.57
|
| Rate for Payer: Healthfirst Commercial |
$10,931.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,441.78
|
| Rate for Payer: Healthfirst QHP |
$6,655.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,418.57
|
| Rate for Payer: SOMOS Essential |
$41,441.78
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,441.78
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,441.78
|
| Rate for Payer: United Healthcare Medicaid |
$18,418.57
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,418.57
|
|
|
Alcoholic liver disease
|
Facility
|
IP
|
$54,303.50
|
|
|
Service Code
|
APR-DRG 2803
|
| Min. Negotiated Rate |
$13,165.00 |
| Max. Negotiated Rate |
$54,303.50 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$54,303.50
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$54,303.50
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$24,134.89
|
| Rate for Payer: Amida Care Medicaid |
$24,134.89
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$54,303.50
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$24,134.89
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$24,134.89
|
| Rate for Payer: Fidelis Qualified Health Plan |
$28,961.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24,134.89
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24,134.89
|
| Rate for Payer: Healthfirst Commercial |
$21,582.00
|
| Rate for Payer: Healthfirst Essential Plan |
$54,303.50
|
| Rate for Payer: Healthfirst QHP |
$13,165.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$24,134.89
|
| Rate for Payer: SOMOS Essential |
$54,303.50
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$54,303.50
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$54,303.50
|
| Rate for Payer: United Healthcare Medicaid |
$24,134.89
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$24,134.89
|
|
|
ALCOHOLIC LIVER DISEASE
|
Facility
|
OP
|
$223.08
|
|
|
Service Code
|
EAPG 00633
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$223.08 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$162.00
|
| Rate for Payer: Healthfirst Commercial |
$223.08
|
|
