|
TRAP MUCOUS SPECIMEN
|
Facility
OP
|
$2.83
|
|
| Hospital Charge Code |
64901235
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.42
|
| Rate for Payer: Aetna Government |
$1.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.92
|
| Rate for Payer: Group Health Inc Commercial |
$1.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.99
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.42
|
|
|
TRAP POLYP SUCTION
|
Facility
OP
|
$252.00
|
|
| Hospital Charge Code |
40200818
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$126.00
|
| Rate for Payer: Aetna Government |
$126.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$201.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$171.36
|
| Rate for Payer: Group Health Inc Commercial |
$126.00
|
| Rate for Payer: Group Health Inc Medicare |
$88.20
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$126.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$126.00
|
|
|
TRAP POLYP SUCTION BRACCO
|
Facility
OP
|
$24.39
|
|
| Hospital Charge Code |
64903120
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$12.20
|
| Rate for Payer: Aetna Government |
$12.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.59
|
| Rate for Payer: Group Health Inc Commercial |
$12.20
|
| Rate for Payer: Group Health Inc Medicare |
$8.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.20
|
|
|
TRAP TISSUE SAFETOUCH
|
Facility
OP
|
$20.84
|
|
| Hospital Charge Code |
64903125
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$16.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$10.42
|
| Rate for Payer: Aetna Government |
$10.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.17
|
| Rate for Payer: Group Health Inc Commercial |
$10.42
|
| Rate for Payer: Group Health Inc Medicare |
$7.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.42
|
|
|
TRAP TISSUE SAFETOUCH
|
Facility
OP
|
$180.00
|
|
| Hospital Charge Code |
40200823
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$90.00
|
| Rate for Payer: Aetna Government |
$90.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$144.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$122.40
|
| Rate for Payer: Group Health Inc Commercial |
$90.00
|
| Rate for Payer: Group Health Inc Medicare |
$63.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$90.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$90.00
|
|
|
TRAP WATER AQUA KNOT II
|
Facility
OP
|
$48.75
|
|
| Hospital Charge Code |
64903298
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$26.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.38
|
| Rate for Payer: Aetna Government |
$24.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$33.15
|
| Rate for Payer: Group Health Inc Commercial |
$24.38
|
| Rate for Payer: Group Health Inc Medicare |
$17.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.38
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.38
|
|
|
TRASTUZUMAB 150MG INJECTION
|
Facility
IP
|
$244.83
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41647808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.42 |
| Max. Negotiated Rate |
$122.42 |
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.42
|
|
|
TRASTUZUMAB 150MG INJECTION
|
Facility
OP
|
$244.83
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41647808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.37 |
| Max. Negotiated Rate |
$159.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.46
|
| Rate for Payer: Aetna Government |
$80.46
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.46
|
| Rate for Payer: EmblemHealth Commercial |
$80.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.49
|
| Rate for Payer: Group Health Inc Commercial |
$80.46
|
| Rate for Payer: Group Health Inc Medicare |
$80.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.40
|
| Rate for Payer: Healthfirst QHP |
$80.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.85
|
| Rate for Payer: SOMOS Essential |
$84.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.37
|
| Rate for Payer: Wellcare Medicare |
$76.44
|
|
|
TRASTUZUMAB 150MG INJECTION
|
Facility
IP
|
$244.83
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41657808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.42 |
| Max. Negotiated Rate |
$122.42 |
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.42
|
|
|
TRASTUZUMAB 150MG INJECTION
|
Facility
OP
|
$244.83
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41657808
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.37 |
| Max. Negotiated Rate |
$159.14 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$134.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.46
|
| Rate for Payer: Aetna Government |
$80.46
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$122.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$140.78
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.46
|
| Rate for Payer: EmblemHealth Commercial |
$80.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.49
|
| Rate for Payer: Group Health Inc Commercial |
$80.46
|
| Rate for Payer: Group Health Inc Medicare |
$80.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$122.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$122.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.40
|
| Rate for Payer: Healthfirst QHP |
$80.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.85
|
| Rate for Payer: SOMOS Essential |
$84.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$159.14
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.37
|
| Rate for Payer: Wellcare Medicare |
$76.44
|
|
|
TRASTUZUMAB 440 MG INJ
|
Facility
IP
|
$86.60
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41643239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$43.30 |
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.30
|
|
|
TRASTUZUMAB 440 MG INJ
|
Facility
IP
|
$86.60
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41653239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$43.30 |
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.30
|
|
|
TRASTUZUMAB 440 MG INJ
|
Facility
OP
|
$86.60
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41643239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$84.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.46
|
| Rate for Payer: Aetna Government |
$80.46
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.46
|
| Rate for Payer: EmblemHealth Commercial |
$80.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.49
|
| Rate for Payer: Group Health Inc Commercial |
$80.46
|
| Rate for Payer: Group Health Inc Medicare |
$80.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.40
|
| Rate for Payer: Healthfirst QHP |
$80.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.85
|
| Rate for Payer: SOMOS Essential |
$84.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.37
|
| Rate for Payer: Wellcare Medicare |
$76.44
|
|
|
TRASTUZUMAB 440 MG INJ
|
Facility
OP
|
$86.60
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
41653239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.30 |
| Max. Negotiated Rate |
$84.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$47.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$80.46
|
| Rate for Payer: Aetna Government |
$80.46
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Cash Price |
$80.47
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$80.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$43.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$49.80
|
| Rate for Payer: Elderplan Medicare Advantage |
$80.46
|
| Rate for Payer: EmblemHealth Commercial |
$80.46
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$80.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$80.46
|
| Rate for Payer: Fidelis Essential Plan QHP |
$84.49
|
| Rate for Payer: Fidelis Medicare Advantage |
$80.46
|
| Rate for Payer: Fidelis Qualified Health Plan |
$84.49
|
| Rate for Payer: Group Health Inc Commercial |
$80.46
|
| Rate for Payer: Group Health Inc Medicare |
$80.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$43.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$43.30
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$81.08
|
| Rate for Payer: Healthfirst Medicare Advantage |
$68.40
|
| Rate for Payer: Healthfirst QHP |
$80.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$80.46
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$84.85
|
| Rate for Payer: SOMOS Essential |
$84.85
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$56.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$64.37
|
| Rate for Payer: Wellcare Medicare |
$76.44
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
IP
|
$28,613.70
|
|
|
Service Code
|
MS-DRG 913
|
| Min. Negotiated Rate |
$12,815.30 |
| Max. Negotiated Rate |
$28,613.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,036.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,052.65
|
| Rate for Payer: Aetna Government |
$28,052.65
|
| Rate for Payer: Brighton Health Commercial |
$21,670.25
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,613.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,808.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,298.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,650.02
|
| Rate for Payer: EmblemHealth Commercial |
$12,815.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,052.65
|
| Rate for Payer: Group Health Inc Commercial |
$28,052.65
|
| Rate for Payer: Group Health Inc Medicare |
$28,052.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,052.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,044.48
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,052.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,052.65
|
| Rate for Payer: Wellcare Medicare |
$26,650.02
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
IP
|
$20,313.59
|
|
|
Service Code
|
MS-DRG 914
|
| Min. Negotiated Rate |
$7,783.53 |
| Max. Negotiated Rate |
$20,313.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,384.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,915.28
|
| Rate for Payer: Aetna Government |
$19,915.28
|
| Rate for Payer: Brighton Health Commercial |
$13,161.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,313.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,675.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,935.74
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,919.52
|
| Rate for Payer: EmblemHealth Commercial |
$7,783.53
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,915.28
|
| Rate for Payer: Group Health Inc Commercial |
$19,915.28
|
| Rate for Payer: Group Health Inc Medicare |
$19,915.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,915.28
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,260.61
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,915.28
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,915.28
|
| Rate for Payer: Wellcare Medicare |
$18,919.52
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
IP
|
$26,104.41
|
|
|
Service Code
|
MS-DRG 086
|
| Min. Negotiated Rate |
$11,294.10 |
| Max. Negotiated Rate |
$26,104.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19,420.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$25,592.56
|
| Rate for Payer: Aetna Government |
$25,592.56
|
| Rate for Payer: Brighton Health Commercial |
$19,097.95
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,104.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22,745.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18,770.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,312.93
|
| Rate for Payer: EmblemHealth Commercial |
$11,294.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$25,592.56
|
| Rate for Payer: Group Health Inc Commercial |
$25,592.56
|
| Rate for Payer: Group Health Inc Medicare |
$25,592.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$25,592.56
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11,900.54
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$25,592.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$25,592.56
|
| Rate for Payer: Wellcare Medicare |
$24,312.93
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
IP
|
$26,660.30
|
|
|
Service Code
|
MS-DRG 083
|
| Min. Negotiated Rate |
$11,631.10 |
| Max. Negotiated Rate |
$26,660.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20,000.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$26,137.55
|
| Rate for Payer: Aetna Government |
$26,137.55
|
| Rate for Payer: Brighton Health Commercial |
$19,667.80
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$26,660.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23,423.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19,330.22
|
| Rate for Payer: Elderplan Medicare Advantage |
$24,830.67
|
| Rate for Payer: EmblemHealth Commercial |
$11,631.10
|
| Rate for Payer: Fidelis Medicare Advantage |
$26,137.55
|
| Rate for Payer: Group Health Inc Commercial |
$26,137.55
|
| Rate for Payer: Group Health Inc Medicare |
$26,137.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$26,137.55
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,153.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$26,137.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$26,137.55
|
| Rate for Payer: Wellcare Medicare |
$24,830.67
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
IP
|
$39,622.55
|
|
|
Service Code
|
MS-DRG 085
|
| Min. Negotiated Rate |
$18,063.22 |
| Max. Negotiated Rate |
$39,622.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,512.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,845.64
|
| Rate for Payer: Aetna Government |
$38,845.64
|
| Rate for Payer: Brighton Health Commercial |
$32,955.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,622.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39,248.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,389.95
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,903.36
|
| Rate for Payer: EmblemHealth Commercial |
$19,489.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,845.64
|
| Rate for Payer: Group Health Inc Commercial |
$38,845.64
|
| Rate for Payer: Group Health Inc Medicare |
$38,845.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,845.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,063.22
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,845.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,845.64
|
| Rate for Payer: Wellcare Medicare |
$36,903.36
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
IP
|
$39,700.34
|
|
|
Service Code
|
MS-DRG 082
|
| Min. Negotiated Rate |
$18,098.68 |
| Max. Negotiated Rate |
$39,700.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$33,593.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$38,921.90
|
| Rate for Payer: Aetna Government |
$38,921.90
|
| Rate for Payer: Brighton Health Commercial |
$33,035.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$39,700.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$39,343.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$32,468.33
|
| Rate for Payer: Elderplan Medicare Advantage |
$36,975.80
|
| Rate for Payer: EmblemHealth Commercial |
$19,536.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$38,921.90
|
| Rate for Payer: Group Health Inc Commercial |
$38,921.90
|
| Rate for Payer: Group Health Inc Medicare |
$38,921.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$38,921.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$18,098.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$38,921.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$38,921.90
|
| Rate for Payer: Wellcare Medicare |
$36,975.80
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$20,009.47
|
|
|
Service Code
|
MS-DRG 087
|
| Min. Negotiated Rate |
$7,599.17 |
| Max. Negotiated Rate |
$20,009.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,067.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,617.13
|
| Rate for Payer: Aetna Government |
$19,617.13
|
| Rate for Payer: Brighton Health Commercial |
$12,849.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,009.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,303.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,629.34
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,636.27
|
| Rate for Payer: EmblemHealth Commercial |
$7,599.17
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,617.13
|
| Rate for Payer: Group Health Inc Commercial |
$19,617.13
|
| Rate for Payer: Group Health Inc Medicare |
$19,617.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,617.13
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,121.97
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,617.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,617.13
|
| Rate for Payer: Wellcare Medicare |
$18,636.27
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
IP
|
$20,483.31
|
|
|
Service Code
|
MS-DRG 084
|
| Min. Negotiated Rate |
$7,886.43 |
| Max. Negotiated Rate |
$20,483.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,560.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20,081.68
|
| Rate for Payer: Aetna Government |
$20,081.68
|
| Rate for Payer: Brighton Health Commercial |
$13,335.65
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,483.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,882.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13,106.76
|
| Rate for Payer: Elderplan Medicare Advantage |
$19,077.60
|
| Rate for Payer: EmblemHealth Commercial |
$7,886.43
|
| Rate for Payer: Fidelis Medicare Advantage |
$20,081.68
|
| Rate for Payer: Group Health Inc Commercial |
$20,081.68
|
| Rate for Payer: Group Health Inc Medicare |
$20,081.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20,081.68
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,337.98
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20,081.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20,081.68
|
| Rate for Payer: Wellcare Medicare |
$19,077.60
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
IP
|
$28,779.20
|
|
|
Service Code
|
MS-DRG 604
|
| Min. Negotiated Rate |
$12,915.70 |
| Max. Negotiated Rate |
$28,779.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$22,208.92
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$28,214.90
|
| Rate for Payer: Aetna Government |
$28,214.90
|
| Rate for Payer: Brighton Health Commercial |
$21,839.90
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,779.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26,010.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,465.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,804.16
|
| Rate for Payer: EmblemHealth Commercial |
$12,915.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$28,214.90
|
| Rate for Payer: Group Health Inc Commercial |
$28,214.90
|
| Rate for Payer: Group Health Inc Medicare |
$28,214.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28,214.90
|
| Rate for Payer: Healthfirst Medicare Advantage |
$13,119.93
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$28,214.90
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28,214.90
|
| Rate for Payer: Wellcare Medicare |
$26,804.16
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
IP
|
$20,329.12
|
|
|
Service Code
|
MS-DRG 605
|
| Min. Negotiated Rate |
$7,792.96 |
| Max. Negotiated Rate |
$20,329.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,400.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,930.51
|
| Rate for Payer: Aetna Government |
$19,930.51
|
| Rate for Payer: Brighton Health Commercial |
$13,177.60
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20,329.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,694.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,951.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,933.98
|
| Rate for Payer: EmblemHealth Commercial |
$7,792.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,930.51
|
| Rate for Payer: Group Health Inc Commercial |
$19,930.51
|
| Rate for Payer: Group Health Inc Medicare |
$19,930.51
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,930.51
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,267.69
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,930.51
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,930.51
|
| Rate for Payer: Wellcare Medicare |
$18,933.98
|
|
|
TRAVASOL 3.5% 1000CC
|
Facility
OP
|
$78.32
|
|
| Hospital Charge Code |
40509795
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$27.41 |
| Max. Negotiated Rate |
$62.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$43.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$39.16
|
| Rate for Payer: Aetna Government |
$39.16
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$62.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$53.26
|
| Rate for Payer: Group Health Inc Commercial |
$39.16
|
| Rate for Payer: Group Health Inc Medicare |
$27.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$39.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$39.16
|
|
