|
Fracture of femur
|
Facility
|
IP
|
$72,786.17
|
|
|
Service Code
|
APR-DRG 3404
|
| Min. Negotiated Rate |
$25,036.00 |
| Max. Negotiated Rate |
$72,786.17 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$72,786.17
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$72,786.17
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32,349.41
|
| Rate for Payer: Amida Care Medicaid |
$32,349.41
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$72,786.17
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32,349.41
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32,349.41
|
| Rate for Payer: Fidelis Qualified Health Plan |
$38,819.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32,349.41
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32,349.41
|
| Rate for Payer: Healthfirst Commercial |
$38,321.00
|
| Rate for Payer: Healthfirst Essential Plan |
$72,786.17
|
| Rate for Payer: Healthfirst QHP |
$25,036.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32,349.41
|
| Rate for Payer: SOMOS Essential |
$72,786.17
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$72,786.17
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$72,786.17
|
| Rate for Payer: United Healthcare Medicaid |
$32,349.41
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32,349.41
|
|
|
Fracture of femur
|
Facility
|
IP
|
$41,315.15
|
|
|
Service Code
|
APR-DRG 3401
|
| Min. Negotiated Rate |
$7,074.00 |
| Max. Negotiated Rate |
$41,315.15 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$41,315.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$41,315.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,362.29
|
| Rate for Payer: Amida Care Medicaid |
$18,362.29
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$41,315.15
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,362.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,362.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,034.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,362.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,362.29
|
| Rate for Payer: Healthfirst Commercial |
$11,587.00
|
| Rate for Payer: Healthfirst Essential Plan |
$41,315.15
|
| Rate for Payer: Healthfirst QHP |
$7,074.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,362.29
|
| Rate for Payer: SOMOS Essential |
$41,315.15
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$41,315.15
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$41,315.15
|
| Rate for Payer: United Healthcare Medicaid |
$18,362.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,362.29
|
|
|
Fracture of femur
|
Facility
|
IP
|
$61,976.90
|
|
|
Service Code
|
APR-DRG 3403
|
| Min. Negotiated Rate |
$13,069.00 |
| Max. Negotiated Rate |
$61,976.90 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$61,976.90
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$61,976.90
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$27,545.29
|
| Rate for Payer: Amida Care Medicaid |
$27,545.29
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$61,976.90
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$27,545.29
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$27,545.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$33,054.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$27,545.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$27,545.29
|
| Rate for Payer: Healthfirst Commercial |
$19,303.00
|
| Rate for Payer: Healthfirst Essential Plan |
$61,976.90
|
| Rate for Payer: Healthfirst QHP |
$13,069.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$27,545.29
|
| Rate for Payer: SOMOS Essential |
$61,976.90
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$61,976.90
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$61,976.90
|
| Rate for Payer: United Healthcare Medicaid |
$27,545.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$27,545.29
|
|
|
Fracture of pelvis or dislocation of hip
|
Facility
|
IP
|
$44,570.59
|
|
|
Service Code
|
APR-DRG 3412
|
| Min. Negotiated Rate |
$8,423.00 |
| Max. Negotiated Rate |
$44,570.59 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$44,570.59
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$44,570.59
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,809.15
|
| Rate for Payer: Amida Care Medicaid |
$19,809.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$44,570.59
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,809.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,809.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,770.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,809.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,809.15
|
| Rate for Payer: Healthfirst Commercial |
$13,501.00
|
| Rate for Payer: Healthfirst Essential Plan |
$44,570.59
|
| Rate for Payer: Healthfirst QHP |
$8,423.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,809.15
|
| Rate for Payer: SOMOS Essential |
$44,570.59
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$44,570.59
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$44,570.59
|
| Rate for Payer: United Healthcare Medicaid |
$19,809.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,809.15
|
|
|
Fracture of pelvis or dislocation of hip
|
Facility
|
IP
|
$48,937.57
|
|
|
Service Code
|
APR-DRG 3413
|
| Min. Negotiated Rate |
$11,554.00 |
| Max. Negotiated Rate |
$48,937.57 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$48,937.57
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$48,937.57
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$21,750.03
|
| Rate for Payer: Amida Care Medicaid |
$21,750.03
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$48,937.57
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$21,750.03
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$21,750.03
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,100.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21,750.03
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21,750.03
|
| Rate for Payer: Healthfirst Commercial |
$20,398.00
|
| Rate for Payer: Healthfirst Essential Plan |
$48,937.57
|
| Rate for Payer: Healthfirst QHP |
$11,554.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$21,750.03
|
| Rate for Payer: SOMOS Essential |
$48,937.57
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$48,937.57
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$48,937.57
|
| Rate for Payer: United Healthcare Medicaid |
$21,750.03
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$21,750.03
|
|
|
Fracture of pelvis or dislocation of hip
|
Facility
|
IP
|
$42,085.49
|
|
|
Service Code
|
APR-DRG 3411
|
| Min. Negotiated Rate |
$6,475.00 |
| Max. Negotiated Rate |
$42,085.49 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$42,085.49
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$42,085.49
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$18,704.66
|
| Rate for Payer: Amida Care Medicaid |
$18,704.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$42,085.49
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$18,704.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18,704.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$22,445.59
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18,704.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$18,704.66
|
| Rate for Payer: Healthfirst Commercial |
$11,025.00
|
| Rate for Payer: Healthfirst Essential Plan |
$42,085.49
|
| Rate for Payer: Healthfirst QHP |
$6,475.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$18,704.66
|
| Rate for Payer: SOMOS Essential |
$42,085.49
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$42,085.49
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$42,085.49
|
| Rate for Payer: United Healthcare Medicaid |
$18,704.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$18,704.66
|
|
|
Fracture of pelvis or dislocation of hip
|
Facility
|
IP
|
$50,022.72
|
|
|
Service Code
|
APR-DRG 3414
|
| Min. Negotiated Rate |
$22,232.32 |
| Max. Negotiated Rate |
$50,022.72 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$50,022.72
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$50,022.72
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,232.32
|
| Rate for Payer: Amida Care Medicaid |
$22,232.32
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$50,022.72
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,232.32
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,232.32
|
| Rate for Payer: Fidelis Qualified Health Plan |
$26,678.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,232.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,232.32
|
| Rate for Payer: Healthfirst Commercial |
$44,058.00
|
| Rate for Payer: Healthfirst Essential Plan |
$50,022.72
|
| Rate for Payer: Healthfirst QHP |
$25,272.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,232.32
|
| Rate for Payer: SOMOS Essential |
$50,022.72
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$50,022.72
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$50,022.72
|
| Rate for Payer: United Healthcare Medicaid |
$22,232.32
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,232.32
|
|
|
FRACTURES, DISLOCATIONS AND SPRAINS OF THE SKULL, CRANIUM AND FACE
|
Facility
|
OP
|
$178.20
|
|
|
Service Code
|
EAPG 00648
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$178.20
|
|
|
Fractures & dislocations except femur, pelvis & back
|
Facility
|
IP
|
$51,070.93
|
|
|
Service Code
|
APR-DRG 3423
|
| Min. Negotiated Rate |
$12,075.00 |
| Max. Negotiated Rate |
$51,070.93 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$51,070.93
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$51,070.93
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$22,698.19
|
| Rate for Payer: Amida Care Medicaid |
$22,698.19
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$51,070.93
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$22,698.19
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22,698.19
|
| Rate for Payer: Fidelis Qualified Health Plan |
$27,237.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22,698.19
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$22,698.19
|
| Rate for Payer: Healthfirst Commercial |
$20,928.00
|
| Rate for Payer: Healthfirst Essential Plan |
$51,070.93
|
| Rate for Payer: Healthfirst QHP |
$12,075.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$22,698.19
|
| Rate for Payer: SOMOS Essential |
$51,070.93
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$51,070.93
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$51,070.93
|
| Rate for Payer: United Healthcare Medicaid |
$22,698.19
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$22,698.19
|
|
|
Fractures & dislocations except femur, pelvis & back
|
Facility
|
IP
|
$39,836.05
|
|
|
Service Code
|
APR-DRG 3421
|
| Min. Negotiated Rate |
$5,490.00 |
| Max. Negotiated Rate |
$39,836.05 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$39,836.05
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$39,836.05
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17,704.91
|
| Rate for Payer: Amida Care Medicaid |
$17,704.91
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$39,836.05
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$17,704.91
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$17,704.91
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21,245.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17,704.91
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$17,704.91
|
| Rate for Payer: Healthfirst Commercial |
$9,443.00
|
| Rate for Payer: Healthfirst Essential Plan |
$39,836.05
|
| Rate for Payer: Healthfirst QHP |
$5,490.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17,704.91
|
| Rate for Payer: SOMOS Essential |
$39,836.05
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$39,836.05
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$39,836.05
|
| Rate for Payer: United Healthcare Medicaid |
$17,704.91
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$17,704.91
|
|
|
Fractures & dislocations except femur, pelvis & back
|
Facility
|
IP
|
$43,612.09
|
|
|
Service Code
|
APR-DRG 3422
|
| Min. Negotiated Rate |
$7,684.00 |
| Max. Negotiated Rate |
$43,612.09 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$43,612.09
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$43,612.09
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$19,383.15
|
| Rate for Payer: Amida Care Medicaid |
$19,383.15
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$43,612.09
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$19,383.15
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19,383.15
|
| Rate for Payer: Fidelis Qualified Health Plan |
$23,259.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$19,383.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$19,383.15
|
| Rate for Payer: Healthfirst Commercial |
$13,044.00
|
| Rate for Payer: Healthfirst Essential Plan |
$43,612.09
|
| Rate for Payer: Healthfirst QHP |
$7,684.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$19,383.15
|
| Rate for Payer: SOMOS Essential |
$43,612.09
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$43,612.09
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$43,612.09
|
| Rate for Payer: United Healthcare Medicaid |
$19,383.15
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$19,383.15
|
|
|
Fractures & dislocations except femur, pelvis & back
|
Facility
|
IP
|
$78,563.65
|
|
|
Service Code
|
APR-DRG 3424
|
| Min. Negotiated Rate |
$23,592.00 |
| Max. Negotiated Rate |
$78,563.65 |
| Rate for Payer: Affinity Essential Plan 1&2 |
$78,563.65
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$78,563.65
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$34,917.18
|
| Rate for Payer: Amida Care Medicaid |
$34,917.18
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$78,563.65
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$34,917.18
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$34,917.18
|
| Rate for Payer: Fidelis Qualified Health Plan |
$41,900.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$34,917.18
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$34,917.18
|
| Rate for Payer: Healthfirst Commercial |
$49,791.00
|
| Rate for Payer: Healthfirst Essential Plan |
$78,563.65
|
| Rate for Payer: Healthfirst QHP |
$23,592.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$34,917.18
|
| Rate for Payer: SOMOS Essential |
$78,563.65
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$78,563.65
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$78,563.65
|
| Rate for Payer: United Healthcare Medicaid |
$34,917.18
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$34,917.18
|
|
|
FRACTURES, DISLOCATIONS, OTHER INJURIES - LOWER EXTREMITY INCLUDING FEMUR
|
Facility
|
OP
|
$362.97
|
|
|
Service Code
|
EAPG 00650
|
| Min. Negotiated Rate |
$263.83 |
| Max. Negotiated Rate |
$362.97 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$263.83
|
| Rate for Payer: Healthfirst Commercial |
$362.97
|
|
|
FRACTURES, DISLOCATIONS & OTHER INJURIES OF THE NECK, UPPER BACK AND CHEST
|
Facility
|
OP
|
$257.67
|
|
|
Service Code
|
EAPG 00656
|
| Min. Negotiated Rate |
$187.46 |
| Max. Negotiated Rate |
$257.67 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$187.46
|
| Rate for Payer: Healthfirst Commercial |
$257.67
|
|
|
FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE LOWER BACK
|
Facility
|
OP
|
$253.35
|
|
|
Service Code
|
EAPG 00657
|
| Min. Negotiated Rate |
$182.83 |
| Max. Negotiated Rate |
$253.35 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$182.83
|
| Rate for Payer: Healthfirst Commercial |
$253.35
|
|
|
FRACTURES, DISLOCATIONS, SPRAINS AND OTHER INJURIES OF THE PELVIS AND HIP
|
Facility
|
OP
|
$333.14
|
|
|
Service Code
|
EAPG 00651
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$333.14 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$240.69
|
| Rate for Payer: Healthfirst Commercial |
$333.14
|
|
|
FRACTURES, DISLOCATIONS, SPRAINS, OTHER INJURIES OF THE SHOULDER AND UPPER ARM
|
Facility
|
OP
|
$215.23
|
|
|
Service Code
|
EAPG 00647
|
| Min. Negotiated Rate |
$215.23 |
| Max. Negotiated Rate |
$215.23 |
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$215.23
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
OP
|
$232.69
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
0310072010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$186.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$127.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna Government |
$6.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.71
|
| Rate for Payer: Brighton Health Commercial |
$174.51
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$186.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$158.23
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.73
|
| Rate for Payer: EmblemHealth Commercial |
$6.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.99
|
| Rate for Payer: Group Health Inc Commercial |
$6.73
|
| Rate for Payer: Group Health Inc Medicare |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.72
|
| Rate for Payer: Healthfirst QHP |
$6.73
|
| Rate for Payer: Humana Medicare |
$6.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$151.25
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.39
|
| Rate for Payer: Wellcare Medicare |
$6.39
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
0143902202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna Government |
$6.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.71
|
| Rate for Payer: Brighton Health Commercial |
$13.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.73
|
| Rate for Payer: EmblemHealth Commercial |
$6.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.99
|
| Rate for Payer: Group Health Inc Commercial |
$6.73
|
| Rate for Payer: Group Health Inc Medicare |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.72
|
| Rate for Payer: Healthfirst QHP |
$6.73
|
| Rate for Payer: Humana Medicare |
$6.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.39
|
| Rate for Payer: Wellcare Medicare |
$6.39
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
7086021174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$51.00
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
0143902202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
6332371505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$66.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna Government |
$6.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.71
|
| Rate for Payer: Brighton Health Commercial |
$90.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$96.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$81.60
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.73
|
| Rate for Payer: EmblemHealth Commercial |
$6.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.99
|
| Rate for Payer: Group Health Inc Commercial |
$6.73
|
| Rate for Payer: Group Health Inc Medicare |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.72
|
| Rate for Payer: Healthfirst QHP |
$6.73
|
| Rate for Payer: Humana Medicare |
$6.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$78.00
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.39
|
| Rate for Payer: Wellcare Medicare |
$6.39
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
6332371505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$60.00
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
7086021174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$56.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna Government |
$6.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.71
|
| Rate for Payer: Brighton Health Commercial |
$76.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$81.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$69.36
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.73
|
| Rate for Payer: EmblemHealth Commercial |
$6.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.99
|
| Rate for Payer: Group Health Inc Commercial |
$6.73
|
| Rate for Payer: Group Health Inc Medicare |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.72
|
| Rate for Payer: Healthfirst QHP |
$6.73
|
| Rate for Payer: Humana Medicare |
$6.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$66.30
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.39
|
| Rate for Payer: Wellcare Medicare |
$6.39
|
|
|
FULVESTRANT 250 MG/5ML IM SOSY
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
4359826202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.71 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.73
|
| Rate for Payer: Aetna Government |
$6.73
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$4.71
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$4.71
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$4.71
|
| Rate for Payer: Brighton Health Commercial |
$18.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$6.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.32
|
| Rate for Payer: Elderplan Medicare Advantage |
$6.73
|
| Rate for Payer: EmblemHealth Commercial |
$6.73
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$6.06
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$5.72
|
| Rate for Payer: Fidelis Essential Plan QHP |
$5.99
|
| Rate for Payer: Fidelis Medicare Advantage |
$6.73
|
| Rate for Payer: Fidelis Qualified Health Plan |
$5.99
|
| Rate for Payer: Group Health Inc Commercial |
$6.73
|
| Rate for Payer: Group Health Inc Medicare |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.73
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.73
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.73
|
| Rate for Payer: Healthfirst Medicare Advantage |
$5.72
|
| Rate for Payer: Healthfirst QHP |
$6.73
|
| Rate for Payer: Humana Medicare |
$6.86
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.60
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$6.39
|
| Rate for Payer: Wellcare Medicare |
$6.39
|
|
