|
CEFUROXIME 3MG/0.3 ML INJ
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41646640
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: SOMOS Essential |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CEFUROXIME 3MG/0.3 ML INJ
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41646640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
CEFUROXIME 3MG/0.3ML INJ
|
Facility
IP
|
$0.01
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41656640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
|
|
CEFUROXIME 3MG/0.3ML INJ
|
Facility
OP
|
$0.01
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41656640
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.01
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: SOMOS Essential |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
CEFUROXIME 500 MG TAB
|
Facility
OP
|
$1.29
|
|
| Hospital Charge Code |
41655335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna Government |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
CEFUROXIME 500 MG TAB
|
Facility
OP
|
$1.29
|
|
| Hospital Charge Code |
41645335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.65
|
| Rate for Payer: Aetna Government |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.65
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.65
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.84
|
|
|
CEFUROXIME 750 MG INJ
|
Facility
IP
|
$3.34
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41653355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.67
|
|
|
CEFUROXIME 750 MG INJ
|
Facility
OP
|
$3.34
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41653355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.67
|
| Rate for Payer: Group Health Inc Medicare |
$1.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: SOMOS Essential |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.17
|
|
|
CEFUROXIME 750 MG INJ
|
Facility
IP
|
$3.34
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41643355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.67
|
|
|
CEFUROXIME 750 MG INJ
|
Facility
OP
|
$3.34
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41643355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.84
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.67
|
| Rate for Payer: Group Health Inc Medicare |
$1.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.67
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: SOMOS Essential |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.17
|
|
|
CEFUROXIME 90 MG/ML INJ PEDIATRICS
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41640110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
CEFUROXIME 90 MG/ML INJ PEDIATRICS
|
Facility
OP
|
$6.00
|
|
| Hospital Charge Code |
41650110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.00
|
| Rate for Payer: Aetna Government |
$3.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.08
|
| Rate for Payer: Group Health Inc Commercial |
$3.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.90
|
|
|
CEFUROXIME IVP < 1500MG
|
Facility
IP
|
$5.05
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41657826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
|
|
CEFUROXIME IVP < 1500MG
|
Facility
OP
|
$5.05
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41657826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: SOMOS Essential |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CEFUROXIME IVP < 1500MG
|
Facility
IP
|
$5.05
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41647826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
|
|
CEFUROXIME IVP < 1500MG
|
Facility
OP
|
$5.05
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
41647826
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.01
|
| Rate for Payer: Aetna Government |
$2.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.90
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$2.52
|
| Rate for Payer: Group Health Inc Medicare |
$1.77
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.52
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.24
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.01
|
| Rate for Payer: SOMOS Essential |
$2.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.28
|
|
|
CELECOXIB 100 MG CAP
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41642350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
CELECOXIB 100 MG CAP
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41652350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
CELECOXIB 200 MG CAP
|
Facility
OP
|
$8.68
|
|
| Hospital Charge Code |
41642045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.34
|
| Rate for Payer: Aetna Government |
$4.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.90
|
| Rate for Payer: Group Health Inc Commercial |
$4.34
|
| Rate for Payer: Group Health Inc Medicare |
$3.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.64
|
|
|
CELECOXIB 200 MG CAP
|
Facility
OP
|
$8.68
|
|
| Hospital Charge Code |
41652045
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$6.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.77
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.34
|
| Rate for Payer: Aetna Government |
$4.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.90
|
| Rate for Payer: Group Health Inc Commercial |
$4.34
|
| Rate for Payer: Group Health Inc Medicare |
$3.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.34
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.34
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.64
|
|
|
CELIAC PLEX DEST NEUROLY
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64680
|
| Hospital Charge Code |
30305729
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$173.03
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$192.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
CELIAC PLEXUS
|
Facility
OP
|
$2,459.50
|
|
|
Service Code
|
HCPCS 64530
|
| Hospital Charge Code |
30305038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.66 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1,054.06
|
| Rate for Payer: Aetna Government |
$1,054.06
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Cash Price |
$1,054.06
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$1,054.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$101.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$895.95
|
| Rate for Payer: Fidelis Essential Plan QHP |
$938.11
|
| Rate for Payer: Fidelis Medicare Advantage |
$1,054.06
|
| Rate for Payer: Fidelis Qualified Health Plan |
$938.11
|
| 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 |
$1,229.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,054.06
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$112.96
|
| Rate for Payer: Healthfirst Medicare Advantage |
$895.95
|
| Rate for Payer: Healthfirst QHP |
$1,054.06
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$1,054.06
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$1,054.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,054.06
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$843.25
|
| Rate for Payer: Wellcare Medicare |
$1,001.36
|
|
|
CELL BLOCK
|
Facility
OP
|
$149.83
|
|
|
Service Code
|
HCPCS 88305
|
| Hospital Charge Code |
40635499
|
|
Hospital Revenue Code
|
312
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$82.41
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$62.66
|
| Rate for Payer: Aetna Government |
$62.66
|
| Rate for Payer: Brighton Health Commercial |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$62.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$78.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$66.56
|
| Rate for Payer: Elderplan Medicare Advantage |
$62.66
|
| Rate for Payer: EmblemHealth Commercial |
$62.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$75.46
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$53.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$55.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$62.66
|
| Rate for Payer: Fidelis Qualified Health Plan |
$55.77
|
| Rate for Payer: Group Health Inc Commercial |
$62.66
|
| Rate for Payer: Group Health Inc Medicare |
$62.66
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$74.92
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$62.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$83.85
|
| Rate for Payer: Healthfirst Medicare Advantage |
$62.66
|
| Rate for Payer: Healthfirst QHP |
$62.66
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$62.66
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$62.66
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$50.13
|
| Rate for Payer: Wellcare Medicare |
$56.39
|
|
|
CELLULITIS WITH MCC
|
Facility
IP
|
$28,514.68
|
|
|
Service Code
|
MS-DRG 602
|
| Min. Negotiated Rate |
$12,755.30 |
| Max. Negotiated Rate |
$28,514.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$21,933.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$27,955.57
|
| Rate for Payer: Aetna Government |
$27,955.57
|
| Rate for Payer: Brighton Health Commercial |
$21,568.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$28,514.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$25,687.64
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$21,198.54
|
| Rate for Payer: Elderplan Medicare Advantage |
$26,557.79
|
| Rate for Payer: EmblemHealth Commercial |
$12,755.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$27,955.57
|
| Rate for Payer: Group Health Inc Commercial |
$27,955.57
|
| Rate for Payer: Group Health Inc Medicare |
$27,955.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$27,955.57
|
| Rate for Payer: Healthfirst Medicare Advantage |
$12,999.34
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$27,955.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$27,955.57
|
| Rate for Payer: Wellcare Medicare |
$26,557.79
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
IP
|
$19,988.24
|
|
|
Service Code
|
MS-DRG 603
|
| Min. Negotiated Rate |
$7,586.30 |
| Max. Negotiated Rate |
$19,988.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13,044.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19,596.31
|
| Rate for Payer: Aetna Government |
$19,596.31
|
| Rate for Payer: Brighton Health Commercial |
$12,828.15
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$19,988.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15,277.88
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12,607.97
|
| Rate for Payer: Elderplan Medicare Advantage |
$18,616.49
|
| Rate for Payer: EmblemHealth Commercial |
$7,586.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$19,596.31
|
| Rate for Payer: Group Health Inc Commercial |
$19,596.31
|
| Rate for Payer: Group Health Inc Medicare |
$19,596.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$19,596.31
|
| Rate for Payer: Healthfirst Medicare Advantage |
$9,112.28
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$19,596.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19,596.31
|
| Rate for Payer: Wellcare Medicare |
$18,616.49
|
|
