|
CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
IP
|
$22,773.34
|
|
|
Service Code
|
MS-DRG 287
|
| Min. Negotiated Rate |
$9,274.72 |
| Max. Negotiated Rate |
$22,773.34 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,948.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$22,326.80
|
| Rate for Payer: Aetna Government |
$22,326.80
|
| Rate for Payer: Brighton Health Commercial |
$15,683.20
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,773.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18,678.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15,414.01
|
| Rate for Payer: Elderplan Medicare Advantage |
$21,210.46
|
| Rate for Payer: EmblemHealth Commercial |
$9,274.72
|
| Rate for Payer: Fidelis Medicare Advantage |
$22,326.80
|
| Rate for Payer: Group Health Inc Commercial |
$22,326.80
|
| Rate for Payer: Group Health Inc Medicare |
$22,326.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22,326.80
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,381.96
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$22,326.80
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$22,326.80
|
| Rate for Payer: Wellcare Medicare |
$21,210.46
|
|
|
CIRCUMCISION
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54150
|
| Hospital Charge Code |
40011165
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.66 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,412.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$104.66
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$116.29
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CIRCUMCISION ADULT
|
Facility
OP
|
$5,365.58
|
|
|
Service Code
|
HCPCS 54161
|
| Hospital Charge Code |
40123187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Cash Price |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2,682.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age
|
Facility
OP
|
$2,915.00
|
|
|
Service Code
|
CPT 54161
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.44 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2,355.42
|
| Rate for Payer: Aetna Government |
$2,355.42
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$2,355.42
|
| 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 |
$2,355.42
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$213.44
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$2,002.11
|
| Rate for Payer: Fidelis Essential Plan QHP |
$2,096.32
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,355.42
|
| Rate for Payer: Fidelis Qualified Health Plan |
$2,096.32
|
| Rate for Payer: Group Health Inc Commercial |
$2,355.42
|
| Rate for Payer: Group Health Inc Medicare |
$2,355.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2,355.42
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$237.15
|
| Rate for Payer: Healthfirst Medicare Advantage |
$2,002.11
|
| Rate for Payer: Healthfirst QHP |
$2,355.42
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$2,355.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,355.42
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$1,884.34
|
| Rate for Payer: Wellcare Medicare |
$2,237.65
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC
|
Facility
IP
|
$22,057.62
|
|
|
Service Code
|
MS-DRG 433
|
| Min. Negotiated Rate |
$8,840.83 |
| Max. Negotiated Rate |
$22,057.62 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15,202.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$21,625.12
|
| Rate for Payer: Aetna Government |
$21,625.12
|
| Rate for Payer: Brighton Health Commercial |
$14,949.50
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$22,057.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$17,804.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14,692.90
|
| Rate for Payer: Elderplan Medicare Advantage |
$20,543.86
|
| Rate for Payer: EmblemHealth Commercial |
$8,840.83
|
| Rate for Payer: Fidelis Medicare Advantage |
$21,625.12
|
| Rate for Payer: Group Health Inc Commercial |
$21,625.12
|
| Rate for Payer: Group Health Inc Medicare |
$21,625.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21,625.12
|
| Rate for Payer: Healthfirst Medicare Advantage |
$10,055.68
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$21,625.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$21,625.12
|
| Rate for Payer: Wellcare Medicare |
$20,543.86
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
IP
|
$34,575.72
|
|
|
Service Code
|
MS-DRG 432
|
| Min. Negotiated Rate |
$1,100.00 |
| Max. Negotiated Rate |
$34,575.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$28,251.42
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$33,897.76
|
| Rate for Payer: Aetna Government |
$33,897.76
|
| Rate for Payer: Brighton Health Commercial |
$27,782.00
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$34,575.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$33,087.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27,305.15
|
| Rate for Payer: Elderplan Medicare Advantage |
$32,202.87
|
| Rate for Payer: EmblemHealth Commercial |
$16,429.70
|
| Rate for Payer: Fidelis Medicare Advantage |
$33,897.76
|
| Rate for Payer: Group Health Inc Commercial |
$1,100.00
|
| Rate for Payer: Group Health Inc Medicare |
$33,897.76
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$33,897.76
|
| Rate for Payer: Healthfirst Medicare Advantage |
$15,762.46
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$33,897.76
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$33,897.76
|
| Rate for Payer: Wellcare Medicare |
$32,202.87
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
IP
|
$16,944.28
|
|
|
Service Code
|
MS-DRG 434
|
| Min. Negotiated Rate |
$5,740.96 |
| Max. Negotiated Rate |
$16,944.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9,871.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16,612.04
|
| Rate for Payer: Aetna Government |
$16,612.04
|
| Rate for Payer: Brighton Health Commercial |
$9,707.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$16,944.28
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$11,561.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9,541.12
|
| Rate for Payer: Elderplan Medicare Advantage |
$15,781.44
|
| Rate for Payer: EmblemHealth Commercial |
$5,740.96
|
| Rate for Payer: Fidelis Medicare Advantage |
$16,612.04
|
| Rate for Payer: Group Health Inc Commercial |
$16,612.04
|
| Rate for Payer: Group Health Inc Medicare |
$16,612.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16,612.04
|
| Rate for Payer: Healthfirst Medicare Advantage |
$7,724.60
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$16,612.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16,612.04
|
| Rate for Payer: Wellcare Medicare |
$15,781.44
|
|
|
CISATRACURIUM 10 MG/ML INJ 20 ML
|
Facility
OP
|
$547.90
|
|
| Hospital Charge Code |
41652597
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$438.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$273.95
|
| Rate for Payer: Aetna Government |
$273.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$438.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$372.57
|
| Rate for Payer: Group Health Inc Commercial |
$273.95
|
| Rate for Payer: Group Health Inc Medicare |
$191.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.14
|
|
|
CISATRACURIUM 10 MG/ML INJ 20 ML
|
Facility
OP
|
$547.90
|
|
| Hospital Charge Code |
41642597
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$438.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$273.95
|
| Rate for Payer: Aetna Government |
$273.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$438.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$372.57
|
| Rate for Payer: Group Health Inc Commercial |
$273.95
|
| Rate for Payer: Group Health Inc Medicare |
$191.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$273.95
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$273.95
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$356.14
|
|
|
CISATRACURIUM 200MG/D5W 100ML INF
|
Facility
OP
|
$450.00
|
|
| Hospital Charge Code |
41657173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 200MG/D5W 100ML INF
|
Facility
OP
|
$450.00
|
|
| Hospital Charge Code |
41647173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 200MG/NS 100ML INF
|
Facility
OP
|
$450.00
|
|
| Hospital Charge Code |
41657178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 200MG/NS 100ML INF
|
Facility
OP
|
$450.00
|
|
| Hospital Charge Code |
41647178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$225.00
|
| Rate for Payer: Aetna Government |
$225.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$360.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$306.00
|
| Rate for Payer: Group Health Inc Commercial |
$225.00
|
| Rate for Payer: Group Health Inc Medicare |
$157.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$225.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$225.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$292.50
|
|
|
CISATRACURIUM 2 MG/ML INJ 10 ML
|
Facility
OP
|
$28.73
|
|
| Hospital Charge Code |
41653350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$22.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.54
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.67
|
|
|
CISATRACURIUM 2 MG/ML INJ 10 ML
|
Facility
OP
|
$28.73
|
|
| Hospital Charge Code |
41643350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$22.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.80
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.36
|
| Rate for Payer: Aetna Government |
$14.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.54
|
| Rate for Payer: Group Health Inc Commercial |
$14.36
|
| Rate for Payer: Group Health Inc Medicare |
$10.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$18.67
|
|
|
CISPLATIN 100 MG INJ
|
Facility
OP
|
$1.92
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41652873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Group Health Inc Commercial |
$0.96
|
| Rate for Payer: Group Health Inc Medicare |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.47
|
| Rate for Payer: SOMOS Essential |
$3.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
CISPLATIN 100 MG INJ
|
Facility
IP
|
$1.92
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41652873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
|
|
CISPLATIN 100 MG INJ
|
Facility
IP
|
$1.92
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41642873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
|
|
CISPLATIN 100 MG INJ
|
Facility
OP
|
$1.92
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41642873
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Group Health Inc Commercial |
$0.96
|
| Rate for Payer: Group Health Inc Medicare |
$0.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.96
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.47
|
| Rate for Payer: SOMOS Essential |
$3.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.25
|
|
|
CISPLATIN 50 MG INJ
|
Facility
OP
|
$3.89
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41652872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Group Health Inc Commercial |
$1.94
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.47
|
| Rate for Payer: SOMOS Essential |
$3.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.53
|
|
|
CISPLATIN 50 MG INJ
|
Facility
IP
|
$3.89
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41642872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
|
|
CISPLATIN 50 MG INJ
|
Facility
OP
|
$3.89
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41642872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.14
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.77
|
| Rate for Payer: Aetna Government |
$1.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.24
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.85
|
| Rate for Payer: Group Health Inc Commercial |
$1.94
|
| Rate for Payer: Group Health Inc Medicare |
$1.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3.17
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$3.47
|
| Rate for Payer: SOMOS Essential |
$3.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.53
|
|
|
CISPLATIN 50 MG INJ
|
Facility
IP
|
$3.89
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
41652872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.94
|
|
|
CITALOPRAM 10 MG TAB
|
Facility
OP
|
$0.10
|
|
| Hospital Charge Code |
41654080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
CITALOPRAM 10 MG TAB
|
Facility
OP
|
$0.10
|
|
| Hospital Charge Code |
41644080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
